After OptumRx took control of United Health, they started to drop pharmacies from their networks citing they want a closed network.No offer of contract was even allowed.
This happened to NYS Medicaid Choice programs and Oxford. In the case of Oxford, no notice was given. NYS Medicaid was contacted and said that they have no control over OptumRx's decision. Bottomline is that OptumRx is competing with the other major insurance companies to grab clients but reduce costs by reducing access.
In addition, they cheat their clients by making them pay the full copayment even though the calculated cost is less. They then deduct that from the pharmacy's fee. For example, the contracted price for Drug A is $4.00 and the patient's copayment is $15.00.
They tell the pharmacy to collect the $15.00 copay (via adjudication) and then they subtract $11.00 from the pharmacy's account.Other PBM's usually would just they the pharmacy to charge the patient $4.00 and end of story.
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