Frequently asked questions

When you register on optumrx.com, you’ll get 24/7 access to a personalized website that helps you manage your health plan.

optumrx.com has tools to help you:

1. Find a doctor or hospital
2. Find and estimate costs for network care
3. See your benefits and what’s covered
4. Get information about preventive care
5. View claim details and account balances
6. Update your account information
7. Print your ID cards
8. Sign up for paperless communications.

It takes just minutes to register optumrx.com and access your health plan.

You’ll need to:

1. Enter the number on your health plan ID card.

A. Don't have your ID card? Use your Social Security number and ZIP code
B. Just have a flexible spending account (FSA) or health reimbursement account (HRA)? When you register, choose “Yes” for an ID card, but use your Social Security number for your member ID and the FSA or HRA Group/Policy number from your employer.

2. Choose a username and password.

3. Enter an email address.

4. Enter a phone number or choose security questions.

That's it! For your security, we'll send you a confirmation email and a letter to the name and address on file.

You must be age 13 or older to use this website. Tools and information may vary based on your plan benefits.

No, your registration stays the same even if you switch employers or if your employer changes group numbers. You will not need to re-register with your new group number or create a new username or password. When you log in with your HealthSafe ID^®, you can choose which account you want to see: the old group number account or the new group number account.

Download on the App Store^® or on Google Play^® for free.

Call us for help all day, every day at the number on the back of your member ID card.

Yes. Sign in to optumrx.com and look on the far left of your home page. The date listed under “Active date” is the day your coverage started.

With almost every plan, you’ll pay less when you choose providers in your network. Here are some easy ways to find network doctors, clinics and hospitals.

1. If you have your health plan ID card, sign in to optumrx.com. Go to your home page and use the provider search tool to look for doctors, clinics and hospitals in your network. Your search will show you a list of providers. You can see cost and quality ratings so you can choose what works best for you.

2. If you don’t have your ID card yet, you can still use the provider search tool. Explore the list of doctors, clinics and providers to find one that’s in your network so you’ll be ready when your plan starts.

3. If you’re on the go, try the mobile app. You can use it to help search for network doctors, urgent care centers, clinics and hospitals on your smartphone. Even if you’re traveling, at your child’s sporting event or away from home, a network option may be close by.

Your deductible is the total amount you pay for drug costs until your health plan begins to cover its share of drug costs. Once you reach your deductible limit, you will enter into the "initial coverage" stage.

In this stage, you will generally be responsible for copays and coinsurance costs, while your plan covers the rest. Once you reach your initial coverage limit, you will enter into the "coverage gap" stage.

During the "coverage gap" stage you may be required to pay more than you did in the initial coverage stage for your drugs. Once you reach your coverage gap limit, you will enter into the "catastrophic coverage" stage.

During the "catastrophic coverage" stage you will only need to pay a small coinsurance or copayment for covered prescription drugs for the remainder of the year. Your health plan will cover the rest. Your coverage will start over at the beginning of a new year, starting with the "deductible" stage. Your plan may provide additional coverage in the catastrophic stage.

When your doctor prescribes a medication, it will fall into one of the drug tiers.  Tiers are a way of explaining how much a prescription will cost. Check which tier your medication falls into.  If your medication is in a higher tier, you can talk to your doctor to see if a lower-cost option is available.

No, you may only use your insurance OR a prescription discount program like Optum Perks. You cannot use both together.

• Check pharmacy pricing online at optumrx.com > Price a drug.
• Or find out what you would pay with a discount program like Optum Perks that is not insurance. Visit perks.optum.com and download a coupon or discount card.

Yes, you can submit your receipt through the standard claims reimbursement process. You can also use your online account at optumrx.com > Information center > Programs & forms. Or download a Claims Reimbursement form from optumrx.com, complete it, and send it to Optum Rx.

They can send an e-prior authorization request to Optum Rx.

You have several options.

• You can use the Optum Perks discount card or coupon for medications that are not covered in the formulary.
  • Go to perks.optum.com and download a coupon or card. Then, show it at the pharmacy counter when you fill your prescription.
• Your formulary should cover another medication that has been proven to work as well as your medication. Sometimes these options cost less than your current medication. Optum Rx will let you know if your medication is not covered. The letter will let you know what your next steps can be. You may need to speak with your prescriber about switching to a covered medication. 
• If your prescriber wants you to keep taking your medication even though it is not covered, they can request a prior authorization. That means your prescriber will have to let Optum Rx know why they want you to keep taking it.

Optum Rx will send you a letter with details about your options and next steps you can take. You can review the decision with your prescriber. Together you can decide if you would like to appeal or if there is another covered option that could work for you.

If you use Optum Home Delivery, they can fill larger supplies for many medications before your trip as long as your prescription still has refills left. Call Optum Home Delivery at the number on your member ID card or on your prescription label to ask for an extended supply.

If you use a retail pharmacy, please call the number on your member ID card to find out if you can arrange for a larger supply. You may need a new prescription.

Make sure you have refills on your prescription before you go on vacation.  If you use Optum Home Delivery, call the number on your member ID card to add an address.  Then, let them know where you would like your medication sent. They can ship to all 50 states.

Effective January 1, 2020, Optum Rx changed how it accepts controlled substance prescriptions. Your doctor must send these to us electronically through a certified system.

Optum Rx will contact your doctor to help them send controlled substance prescriptions electronically, if they don’t already do so. Here are some common questions about this change.

Controlled substance prescriptions are regulated based upon their medical use, potential for abuse, and safety. You can check with your pharmacist, doctor, or click the link below to verify if your medication is controlled.

Controlled Substances Act

Optum Rx is leading the charge to fight the opioid crisis with safer and more secure ways to send prescriptions. Our goal is to help you, your doctor, and our country safely use these powerful medications.

No. Your doctor must send prescriptions for controlled substances to us through a certified electronic system. Paper or fax prescriptions will not be accepted. Talk about this change with your doctor to make sure they are able to send these prescriptions to us electronically.

No. This does not apply to members residing in Alaska, Guam, Puerto Rico, and the US Virgin Islands, or members that reside in nursing homes or are in hospice.

Once you have your new account set up with home delivery, most current home delivery prescriptions with valid refills will transfer. Prescriptions for controlled substances will not, so you’ll need a new prescription from your doctor.

Choose from one of these ways:

• Electronically prescribe via your doctor.
• Go to optumrx.com.
• Use the Optum Rx app.
• Call the number on your member ID card.

New and refill prescription orders will arrive within 5 days from the date Optum Rx receives your completed order.

Provide us with your mobile phone number and select the types of message reminders you would like to receive.

Once you’ve provided your mobile phone number, you will receive the following text message on your phone:

• Thank you for signing up for text message reminders at optumrx.com. Reply with “RXJOIN” to complete your request.
• Within 2 – 3 business days, you’ll start receiving the reminders you selected.

Please note: Standard text message and data rates may apply. Please see our Privacy Policy.

To stop receiving text message reminders from us reply “STOP” to the next text message you receive from optumrx.com

Reply “HELP” to the next test message you receive form optumrx.com or call 1-800-788-4863.

You can sign up for a variety of helpful text message reminders and updates about your prescriptions:

• Medication reminders
• Dosage reminders
• Refills/Renews
• Order confirmations

Supported Carriers: AT&T, Verizon-Alltel, T-Mobile®, Sprint, U.S. Cellular, MetroPCS, Virgin Mobile, Cricket, nTelos, Cellcom, C Spire Wireless (Cellsouth), Carolina West Wireless, Appalachian Wireless, Chariton Valley Cellular, Coral Wireless, Cross (dba Sprocket), OTC Wireless, Duet IP, EpicTouch, Leaco, Mosaic, femont Sagebrush, Peoples Wireless, Pine Cellular, Pioneer, Revol Wireless, Rina 11€ “Custer, Rina-All West, Rina- Cambridge Telecom Coop, Rina- Eagle Valley Comm, Rina- Farmers Mutual Telephone Co, Rina- Nucla Nutria Telephone Co, Rina- Silver Star, Rina- South Central Comm, Rina- Syringa, RinaUBET, Rina-Manti, United Wireless, Aio Wireless, ACS Wireless, Bluegrass Cellular, Cellone Nation, Cellular One of East Central Illinois, Chat Mobility, Element Mobile, Flat Wireless, LLC, GCI Communications, Golden State Cellular, Illinois Valley Cellular, lmmix/Keystone Wireless, Inland Cellular, iWireless, Nex-Tech Wireless, Northwest Missouri Cellular, Panhandle Telecommunications, Plateau Wireless, SouthernLINC Wireless; SouthernLINC Communications, SRT Wireless; SRT Communications, Thumb Cellular, Viaero Wireless, West Central Wireless (WCC). T-Mobile is not liable for delayed or undelivered messages.

Note: When you give another person access to your account, they will be able to see information about you and your prescriptions. You should be careful about who you choose to have access to this information. You may also wish to review your choice of  “Caregiver” or “Account Manager” on a regular basis by selecting “My Account Manager”.