My daughter was prescribed a drug a year ago while I had another insurance. The drug was approved and covered by my insurance.
The drug would normally cost over $300. My doctor chose this drug based on my daughter's history and issues. It has been successful in her treatment for a year. Many months after the initial prescription, my employer switched insurance and I ended up with OptumRx for Rx drug coverage.
When we went to fill the prescription, it was denied coverage. They require my daughter to try several other drugs first before they will cover the drug she has been on successfully for a year. When I and the doctor explained to them it would be detrimental to switch her off a drug she's been on for a year, just to check all their boxes, they did not care. They would not listen and no one in the company is empowered to THINK and make decisions based on circumstances that are not covered in their policy or training.
The boxes have to be checked. So, in order to check their boxes, my doctor has to prescribe at least two other drugs first. We have to take my daughter off the one she is one and put her on another drug. These drugs affect the Central Nervous System and have many side effects.
So, we are being forced by the insurance company to expose my daughter to these side effects (which she does not experience on the current drug) in order to check the boxes. I wish someone at OptumRx would explain to me how this helps my daughter. Explain to me why my daughter's well-being is not at the top of the list of goals. This is all about money; however, this has the potential to cost OptumRx MORE money in the long run.
It is bad policy for my child. It is bad policy for OptumRx. I cannot afford to pay over $300 per month for this drug. I already pay over $800 per month to this insurance company that doesn't have my child's best interest as their core value.
It's not only maddening.
It is disgusting. Their core value is their profit margin.
Product or Service Mentioned: Optumrx Prescription Refill.
Reason of review: Order processing issue.