In the open enrollment period for 2017, I searched for a Part D Plan under the NJ Group Retirees Benefits whose formulary contained all my prescriptions. I chose a Horizon Blue Medicare Advantage Plan with a higher premium, but with the assurance that all my prescriptions, doses, and 90 day supplies were covered. All worked well.
Optum Rx notified beneficiaries late in 2017 of their role in the NJ Retirees State Benefits Medicare Program for 2018. The open enrollment period was already underway and given the holiday season, instead of doing the painstaking research I did the year before, I called Optum Rx Customer Service to check if there would be any formulary or coverage changes. I was assured by a friendly representative, whose first name I have, that no changes would be made to coverage; ie. we are just a new administator.
Therefore I did not make any changes during the open enrollment period. It is only March, and I have received 3 letters, "updated" formulary information (provided only after open enrollment), containing challenges to medications I have safely and effectively taken for years prescribed by the same primary care physician for years; 2 are Schedule 4 controlled substances; one is not a controlled substance.
Optum Rx is shifting the work they should be doing.to the consumer. They are a representative of the federal and state government employers through which we have paid taxes all of our working lives through Payroll deduction with additional deductions for social security, Medicare, etc.
That makes OptumRx a public servant as are our elected officials who contracted with Optum, presumably under the Christie administration. We have paid our dues for health insurance coverage for those of us on Medicare. These are not the years of our lives to be harassed and,overburdened with fruitless phone calls, extra paperwork, stress and and aggravation.. WE HAVE WORKED AND ARE STILL PAYING FOR THIS INSURANCE. It is not a gift.
The so-called "generous" transition supply was filled, with requests that I talk to my doctor about using other medications, or file for an exemption under new rules. I would not have a legal prescription to bring to the pharmacy if these issues had not already been discussed with the doctor multiple times , approx. every 90 days.
I would like to know transition to what? No coverage? It would be happy to sign a release for Optum Rx to contact my physician to acquire whatever information they are looking for. A review of their corporate structure reveals only 1 medical doctor and the rest with backgrounds in finance.
They have already had a class action suit filed against them in 2013.
Having read what others are going through dealing with Optum Rx it seems to be a nightmare organization hoping we will just give up and self pay the full retail price.
Many of us have serious or potentially life-threatening illnesses, myself included. It is negligent, irresponsible and dangerous to change or stop a medication(s) which have kept people stable and functional.
I refuse to use their pharmacy, call, or do any paperwork; or play their game; Next year will be different; however, I will shout out to officials in state and federal governments, any relevant agencies on the state and federal level; they need to be investigated for their business practices and write to any newspaper or journalist interested in your stories.
AARP has issued a warning NOT to use their pharmacy.
A start...any class action, and I am in. Age and discrimination against people with disabilities are all legitimate causes of action.
Product or Service Mentioned: Optumrx Adderall Prescription Refill.
Reason of review: Order processing issue.