Optum Rx Mail Order Pharmacy is terrible

[Hokie]

I am on a Medicare Advantage plan offered by AARP/United Health Care. They use Optum Rx for mail order prescriptions. I changed from the UHC Medicare Supplemental plan to the Medicare Advantage plan at the beginning of 2021.

On the Supplemental plan CVS handled mail order prescriptions. I never had a single problem with them. When I switched over in January my first problem was that Optum RX said they could not port over my prescriptions that still had remaining refills from CVS. OK, no problem, I had my doctor write all new scripts to Optum. One of my prescriptions is for a combo high blood presure med. It is a generic for Exforge or Alodipine/Valsartan/Hydrochlorothiazide. I had never experienced any problem getting it from two other mail order pharmacies.

I waited for weeks on the BP medication and all Optum could tell me is that it was out of stock. No they did not know when it would be in stock. So finally when I got down to a week's worth of pills someone at Optum RX finally said they could fill it with individual prescriptions for the components. However my doctor would have to wrote new scripts. So that is how I proceeded. Now I had to take two extra pills every day.

Last month at my six month checkup I asked my doctor to try to see if I could get the combination drug again. So he apparently wrote the prescription for Exforge, which is the brand name. Optum RX first sent me an email saying order needed a clarification from the doctor. The next email said the order was cancelled. The third email said they were filling the Exforge order and the cost was $1450 for a 90 day supply! The cost of the generic I was supposed to be getting was $0.00. The fourth email said the prescription was under review.

This is a simple medication that I have taken for over 10 years and never had a problem getting. Now Optum Rx is wearing out my patience. I have checked the AARP forums and others have found them to be terrible as well.

Now I have no clue what is going on. Their customer service folks are polite but are all ESL clueless and spend the last 5 minutes on the phone trying to get you to say they have solved the issue (they never do) and making sure you give them a good rating.

[SoCalNative]

1. They are the worst

I never had more problems that when my insurance used them. Thankfully they dumped them last year and now use CVS Caremark. Have not had any issues since.

[JohnSJ]

2. Just have your doctor write a new script and sent to CVS, or whatever local

pharmacy you prefer

The problem with mail-order meds is what you are going through now

By going local, If your local pharmacy doesn’t have something in stock, you should be able to have the script sent to a pharmacy that does have it in stock

Also by going local, you have an option to go through facilities like goodrx which is accepted by most local pharmacies

[Hokie]

4. There is a copay on my plan for locally filled prescriptions

It isn't much but why should I pay $30 for a prescription that should be free and delivered to my mailbox?

[JohnSJ]

6. It depends on the frequencies of the hassles you are going through. If it does not happen

very much, then it probably isn’t an issue.

However, if you have a delay in getting a critical medication that you must have, and the mail-order indicates it is out of stock, or they don’t know when it will be back in stock, one would have to go through a local pharmacy in that case if they need the medication, copay or not

[Me.]

3. And Could Care Less

my local pharmacy does just fine by me and appreciate the business

[yorkster]

5. Have aarp unh rx plan

They mail out promo materials for Optum rx all the time.
I continue to use my local large supermarket pharmacy, which is quite good . Why the hell would united health think people would want to switch to mail delivery of medicines, especially given the current usps problems.

I'm afraid they may switch over to mail delivery only, in which case I look for another plan.

[JohnSJ]

7. I think it also depends if you are on an advantage plan or a supplemental one. You have more

flexibility with a supplemental plan, but you are paying a higher premium

Also, if you are on a supplemental, then you need a separate Part D plan for medications, while you don’t with an advantage plan

[yorkster]

8. Should have been more specific

I have a supplemental health insurance plan with a separate prescription plan.
Have avoided medicare advantage for several reasons..

[JohnSJ]

9. Same here with me

[Hokie]

12. Here was the math for me

In Florida my supplemental plan had a monthly premium of over $165 per month. That is $2k per year. I found for routine visits to primary care physicians and specialists that the supplemental plan N paid exactly nothing over what Medicare paid. It only kicked in for hospital care. There was no dental or vision benefit either. My Part D drug premium was around $15 per month or $180 per year.

On my Medicare Advantage plan my premium is $0, my co-pays for specialists are $20, and dental and vision coverage are included. I pay nothing for my semiannual cleaning and X-rays at the dentist. I also get wellness benefits that can amount to $200-$400 per year. Part D is included and my drug costs are $0. Yes, I have to research in network doctors but so far I have been successful in finding doctors.

One problem with Medicare Advantage HMO's has been non-portability. That is important since we split time between Florida and Colorado. The AARP/UHC MA plan now is nationwide. Before I had to notify them when we were living at another address. Now the plan is nationwide.

I see no reason to go back to a supplemental plan as long as I can find doctors in network I can be comfortable with visiting.

[dwayneb]

15. Advantage plans are great until you get really sick

You hit on one of the problems with Advantage - finding good doctors in your Network.

What you also find is that doctors and health care systems hate Advantage plans and in general love Supplemental plans.

This is because Advantage plans will fight tooth and nail not to pay a claim, and will force you to go through multiple lower cost alternatives before finally approving the treatment that you really need. And in some cases they won't pay claims at all.

If you remain healthy Advantage plans are fine. It's when you get seriously ill that you discover that you do indeed get what you pay for.

[Hokie]

10. Yes, you are correct

When I was on the the UHC Supplemental plan I chose Wellcare for Part D and their mail order pharmacy was CVS Caremark. I would gladly go with them again if I could. I started looking at the MA plans because when we changed our permanent address to Florida in 2020 my monthly premium on the supplemental plan went up 50% to $165. That caused me to look at the MA plans last year.

[JohnSJ]

11. It is a personal decision and depends on a lot of factors, not the least is affordability

[Hokie]

13. Update from Optum Rx

Last edited Mon Nov 29, 2021, 02:26 PM - Edit history (1)

I got an email today. Now Optum Rx says that their supplier does not manufacture the drug. It is listed on there website however.

[Hokie]

14. I finally got a call from a very nice person at Optum Rx

She was very polite and explained that for unknown reasons the 3 in 1 medication was no longer available from their manufacturer. I know they use Mylan for some drugs and Mylan still makes it so whom do I believe?