OptumRx
Reviews and Complaints

If my doctor prescribed for me a new medication called simzia and this was back on july 12th after numerous phone calls saying it was approved and then not approved and then I needed a copay card and miss information from your agency, people do not know what is going on. I had to cancel my rx and I will not go to any further because i'm writing all of this to the missouri state board of pharmacy as well. Also filing a complaint to to get you off of my medicare. Not only mine but sending emails to them as well for all the other poor suckered that are being scammed by your agency as well. 8b do not want you as my mail order pharmacy.

My doctor submitted a PA to Optum on 6-30-21. I received a letter from Optum stating med was approved thru 6-30-22.

The FIRST time, pharmacy ran prescription promptly and it did not go thru. I called Optum and was told they could not find the prescription in the system. I called dr and they did send the PA which is why approval granted from Optum 6-30-21. I then called Optum back and explained SITUATION again. This time I was told it was coding problem. Optum requested pharmacy call them directly to get "correct codes". My pharmacy entered new codes and the prescription did not go thru the SECOND time. I called Optum back and was told there was a restriction on account due to outstanding payment (HSA card is on file). Optum did some checking and I was sent an email stating restriction lifted so pharmacy can run prescription. Pharmacy ran prescription and it did not go thru the THIRD time. I called Optum back and was told the "dosage" was an issue and needed another PA from dr. Dr submitted another PA. I confirmed with my dr the PA was filed and accepted by Optum. My pharmacy ran the prescription and it was rejected a FOURTH time. All of the communications between Optum/dr/pharmacy took 2 weeks. I complained again to Optum about the erroneous reasons why they could not approve the prescription. I was told by Optum they would research and I insisted I would stay on hold to get the update (no trust in Optum at this point). I was on hold for 2 hrs and 28 minutes and then the call was dropped by Optum.

At this point, I was in tears. How could Optum screw this up so much? Then i received a voicemail from Optum stating the prescription was approved. I called pharmacy and the FIFTH time it was rejected. I called Optum back and guess what, there is an outstanding amount on the account….I stated again HSA card in file, process the dang $60. So, the amount was processed and i called pharmacy again and another rejection for the SIXTH time. Called Optum and was advised the med was not on the formulary! Optum escalated and got the PA approved. My pharmacy submitted for the SEVENTH time and it went thru. I was charged $300 for the med. At this point I paid the money and had my prescription in hand. Today I get a call from the care coordinator at the TPA level and was told the prescription was approved for 30 days only. We patched in Optum and was told the approval was for 12 months. I don't believe a word Optum says. I am moving my prescriptions from Optum as my sanity is borderline after this experience. I also requested mfg assistance with the $300 and was told my dr needs to file a PA for a cost reduction. This is the biggest lie Optum has ever told. The Optum service person stated they don't take coupons from mfg or allow discounts, I could only get discount from retail pharmacy. So, if the med was approved, why did the medication cost my $300? My copay is $35 for non-generic meds. . Parting comments from Optum, , the $300 cost was due to med mot on formulary, , , well a exception was made therefore it is Covered. Optum stated contact your pharmacy about the mfg coupon, we can't help you. .

I am pretty certain that Optum has several licenses to handle and dispense medications. How can Optum keep their license when countless E&O's occur? Why are they allowed to be in business? Why are they not fined for jerking people around who need their meds as a matter of life and death?

My account was locked. Now when I log in I'm taken to a United healthcare site. The optumrx app released a new version last week. I've been unable to login since then using the app.
I have been on the phone with a representative who has a very bad attitude. She hung up and I waited for the review and it never came. She did not know what she was doing nor did the rep Ken? who transferred me

My interactions with OptumRx have, unfortunately, been mandatory because of some partnership with my insurance company - each one worse than the last.

The lack of competence on every level shows a blatant disrespect for the well-being of its customers. On multiple occasions, I have been left without life-saving medications because of OptumRx's errors. On top of fumbling every regular order refill, the amount of misinformation - received both in any phone call and interaction.

But the most sinister and mind boggling thing to me is the tremendous amount of misinformation. They will send "confirmation" emails that your medications have been processed and are in the mail when in fact, the prescriptions have not even been written by the doctor, sent to OptumRx or reviewed by insurance. As someone who has to rely on medications to stay alive, receiving false information on a consistent basis is absolutely a nightmare.

This company should be shut down immediately and taken to the cleaners for every penny they've stolen from the members & patients that have suffered for having to rely on them for their negligent and irresponsible approach to providing healthcare.

Horrible company cannot provide prescriptions on time constantly lied to by multiple people failure to deliver I do not recommend this company and I'm leaving them after this month to find a new pharmaceutical supplier

I have been taking metformin for 15 years. Then 4 yrs ago my doctor changed it to januvia because metformin wasn't working that good. Then my plan was with cvscaremarx. There was no issues getting my medication. Then january, 2021 optum took over my plan. From day one, they have been harrasing me to change my medication. Basically they are deciding which medication I should take. Finally they arbitrarily refused to send me the medication. I pleaded with them its a maintenance drug. I need to take it everyday. They didn't give a damn. They were acting like empowered legel mafia. I even pleaded if I don't take the medication I will go in a coma, for now to give me a months supply and then we figure out. They refused. That's how optum manipulate with my medication.

I called in 2 renewals for steroid rye drops used for corneal and retinal eye pressure control.
I was told they are now out of network and would cost $770 and $590 for 3 month supply. I told them to send one month and to expedite. They promised me Sat delivery and it is now the following Wednesday!
I had to have my doc call in a substitute locally costing $125 for the one I'm being charged $770. For. Also there is a discount site which said I can get it for $60 and $32!
Durezol and Prolensa are the names

I want to return them upon receipt. This is insane. I was disconnected by at least 9 different representatives and told to call the post office myself when I saw the tracking was sent conventional delivery even though I agreed to pay for fedexp. Which they said no charge to expedite. I am FURIOUS. My husband and I are 89 and 90 and get our meds from this nightmare service

I have United Health care coverage, and a Cimzia co-pay assistance card to use with each order of my specialty drug, Cimzia. I have spent at least 6 hours on 2 occasions with Co-pay Assistance, myself and OptumRX on conference calls in March 2021 and again today, on 6/3/21 as the billing department at OptumRX can not read notes and follow through and bill my Copay assistance card so that I can continue to receive my Cimzia injections each month.

How many times must Co-pay assistance card, myself waste dealing with Optum RX to simply bill my co-pay assistance card which is loaded to not have interruptions in delivery of injectable medication which I require every 2 weeks.

I am a nurse having worked at insurance industry and I know this process should be effortless as I have worked with other specialty pharmacies and they had no difficulties with this process, but Optum RX is the WORST.

I want this resolved once and for all because I can not spend hours repeating the same information over and over again.

Karen Kieras
415.690.9600

You can take my complaint down but I will post every day how you are all slowly crippling and killing my father! You are murdering him over one prescription your rich company did not want to pay for. You should be disgusted with yourselves and even more for taking my complaint post down quickly... Don't you look guilty. Once again, I hope the day you meet your maker, if you all even believe on god, I hope he judges you accordingly and you end up where you belong! I am sure there are plenty more before my father that you have slowly killed

I have contacted this company (6) times and have been given the run around.

4/12/21 Spoke with a Representative in the specialty Dept requesting an explanation of Benefits.
Advised I needed to request this from my insurance company, United Health.
Advised her that I did not have United Health. She continued to debate- I
ended the call.
4/12/21 TT my Med insurance provider. they did not have a Botox claim for me so they could not provide an EOB.
4/14/21 TT another representative. they do not have EOB but she would email me what she had.
4/14/21 Called BSBC -Rep advised that BCBS provide the health care optium RX is responsible for the Medicine. I said they did not have an EOB for me. Advised that I contact my Dr that did the injections and ask for a claim #.
4/21/21 TT Doctors office- advised no claim # was provided by OptimRX for my shipment.
4/21/21 TT OPtumRX requested an EOB. REp took my info and said someone would contact me within 48 hours.
4/21/21 Bianca from Optum RX called me at 6:00pm. I advised her that I needed a EOB. She said that was not available and that she would send me what she had that should suffice. I said great if she could email it. She said no that they would mail it and I would receive it in 10 to 15 days. I asked if she could expedite my request. She said she could try. i explained
that this was my 6th call and i have just been given the run around. I asked for her Manager so that I could escalate my request and have it expedited. She advised that her manager could not expedited for any sooner than she could. I said you said that you would try but could not promise for sooner. She got rude and so did I. she had me waiting on the line. then I hear a ling ringing. She had transferred my call w/o letting me know. In the mean time I was receiving a call (call waiting) I did not answer because did not want to lose the call that i received. The line went to a VM of Julie (OPTRX--I hung up. I called the # that was calling me an it was and (OPTRX -Julie) [protected]. I left a vmessage advising of the call I received from Bianca and did not know if she was expediting my request or what was going on. Requested that she return my call. Did not hear back. So tired of trying to work with this company it should not be this difficult.
please help. The only rude rep was the one that called me 4/21/21. The worst is that I am paying for this service through my health care.

So I called this week to for fill my order. Any other time I have it sent expeditiously. The lady asked me will I miss any injections because she tried to have it delivered on 20th. I advise her I have an 18th injection that needed to given to me. She said okay no problem we will have it delivered Sunday. I called to check on this and the representative stated that no delivery happens on Sunday. So we have incompetent people [censored]ing up and setting false expectations. This shot is to stop pre term labor and I have to take it same day. Now I have to wait till Tuesday. The lady who took my refill should be fired immediately. Like this is literally a serious matter.

I'm new to uhc, and optumrx for prescriptions is the worst. Every rep I call, I get a different answer with any question. Been on the phone everyday this week trying to get my mail order prescriptions filed and billed correctly. I still haven't resolved my specialty pharmacy medication. One day i'm told they will file my 2nd ins express scripts and the next day i'm told it's not in their network. I will cancel my insurance if inhave too! My co-pay is over $1000 for specialty med simphoni.

Optum Rx has the absolute WORST customer service I have ever had to deal with, and unfortunately, I have to deal with them often. The company's billing system is never straightforward - we regularly receive bills for things that seem to have already been paid. The bills do not have claim numbers on them, so the customer needs to make an assumption for what it is for (which is sometimes unclear, since sometimes they bill at the time of fulfillment and sometimes they don't). Each time this happens, when I call OptumRx customer service to resolve the payment issue, I get a runaround of transfers until someone registers the issue and I am told that it will be resolved. But it never ever ever ever is. Stay away if you can.

I am so disgusted with your lack of service. Poor customer service or should I say lack of any, website issues, and right now yet another delivery issue. I have been waiting on an important Rx that first was said to arrive March 3rd, then every day it is pushed to the next day and now today it had said delivery today but the USPS website is down for maintenance since 1 a.m. with no further updates available. The pkg is close enough I could drive to get it. It is very important I get this asap as it is very new to me and I am out. Since Optumrx assured my doctor when I would get this, no backup order could be placed here at a local pharmacy. Your people can't or don't ever want to assist. It's a miracle if you can understand them if they do talk. Last prescriptions I got took over 2 weeks to arrive, leaving me without for that long. I am forced to order from you because of lower pricing. The copay locally was way too much. Since I am required to deal with you frequently, isn't there something you can do to expedite urgent prescriptions so we aren't left without and waiting weeks for it to arrive?

Thank you.

Lori Jarvis
[protected]

OptumRx has denied covering my 23 year old daughter's ADD medication that she has been on since she was 11 years old. She is presently attending medical school at University of Texas-Houston and still needs the medication. They denied the first PA stating that she had to be on the medication before she was 12 and that she had to be using it for educational purposes both of which we could have proved. They denied and did not give us an opportunity to show that she fulfilled these 2 requirements. Spoke to HR with my work who just now said that she has to see a psychiatrist to have this medication covered. At what point does OptumRx stop coming up with different hoops to jump through before they will fulfill their responsibilities? They filled my 18 year old daughter's prescription for the same exact medication from the same physician. I am seeking legal help as well as filing a complaint with Texas Department of Insurance, the Better Business Bureau, and the Commissioner of Health Insurance for the state of Texas. Be honest with your customers. We are not idiots and are able to determine when we are being given the runaround.

Mi doctor pidió una medicina (synvisc) a esa farmacia, yo pague el día 17 de febrero-2021 $300.00 dólares y me prometieron que el doctor la tendría para el día 23 de febrero y hoy día 24 no me aseguran que puede estar en la oficina del doctor el día 26. Mi recomendación a todos los doctores de ahora en adelante es que no hagan negocio con ustedes. Yo soy imposibilitado, no puedo caminar y necesito esa medicina para mi rodilla. La consulta del medico es apollo pain care, la doctora es padmajar r. Yatham. La supervisora de la farmacia que se llama air me mintió y no sabe lo que dice o no sabe que en los eu se pone una medicina de un día para otro
Mi nombre es carlos cabrera y me boy a preocupar que todos los doctores que yo veo no hagan negocio con ustedes

Started on 2/14 when the order was supposed to be filled, I looked at the order status and it stated "on hold" When I requested info I was told that it was going to be expedited and mailed set to receive on 2/18. Well 2/18 came and the order status still showed processing. So I called to find out it was still not mailed. I called 2/19, 2/20 both stated delivery of 2/23 with no reason for the delay. Today now 2/23 it still has not been shipped and all I get is the run around, placed on hold with no answer. I was lied to and still do not have my medicine. By the way, I am waiting for Insulin. This has to be the worst service, and lack of respect. Do they want for me to die?

I ve been trying to get my prescription filled since February 5 for a new different prescription. They filled one part and not the other. I spoke with a representative on the 8. They stated I need the dr. to call for a PROIR AUTHORIZATION my dr. call I go to pick it up cause OTIMA RX sent me a STATING it's approved. Only to find out when I got to the pharmacy it wasn't straighten out. I had to call OPTUMRX BACK ON FEBRUARY 10 the young lady stated LET ME SPEAK WITH THE PROIR AUTHORIZATION DEPT. CAME ON THE AND STATED MY DR. NEED TO CALL BACK AND MAKE A NEW PROIR AUTHORIZATION FORM. SO ON FEBRUARY 11 the Dr Office call me to let me know it's been done. I go to pick my prescription up on February 12 only to find out they still didn't put it through. I call OPTUMRX SPOKE WITH A PROIR AUTHORIZATION ERIC WHO WAS VERY OBTUSE TO THE POINT HE ASKED ME TO EXPLAIN AND WHEN DOING SO HE CAUGHT ME OFF AND WAS VERY RUDE. I ASKED COULD I SPEAK WITH SOMEONE ELSE HE SAID YES PUT ME ON HOLD AND NEVER RETURN TO THE PHONE ONLY FOR THE SURVEY OF THE CALL TO COME ON. HE ASKED A QUESTION AND HAD ABSOLUTELY NO PATIENCE IN LISTENING TO THE RESPONSE. MAYBE OPTUMRX NEEDS BETTER TRAINING FOR THEIR EMPLOYEES. IVE GOTTEN THE RUN AROUND ALL WEEK. I'M SURE THEY WOULDN'T WANT THEIR PARENTS OR FAMILY MEMBERS TO BE TREATED THAT WAY.

Both my wife and I have experienced delays in renewal of prescriptions, at multiple times, particularly with Express Scripts. Your Laguna Niguel location clearly has a lot of dysfunctional behaviors that show customer care is not a team commitment. After contacting the Laguna Niguel office and your corporate help line, I was transferred into oblivion or simply hung up on three times today.