OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. Our high-quality, integrated services deliver optimal member outcomes, superior savings and outstanding customer service. We are an Optum company - the world's largest provider of integrated health services.
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I am a Crohn’s Disease patient. In order to live life similar to those who are healthy, I have a team of doctors, medications and pharmacies I depend on. I write this complaint about the pharmacy, BriovaRx. Briova is one of many pharmacies I use, generally I go to Walgreens and Duane Reade. I am forced to use Briova as the medication I take for Crohn’s is considered a specialty drug by my insurance company Oxford (United Healthcare). Briova has major issues with their system. They do not notify a patient of issues with a prescription or refill until it is time to schedule a refill. This is counterintuitive as it notifies the patient too late for the next refill. I was notified last Friday that Briova required action from me and my doctor’s office, my prescription was expired.
I informed Briova that I am due for my next dose the following Wednesday. I was assured this was not a big problem and that they would turn the new prescription around as soon as it is received. I was not informed about their 72-hour turnaround time. This was brought to my attention today, Wednesday, September 19th, 2018.
I called Briova on Tuesday, September 18th, 2018 to inform them that my doctor sent in a new prescription and to check whether there were any issues that I can help resolve by coordinating with my doctor. I was told there were no issues with the prescription but that it could not be passed onto the pharmacist until the next day. No proper reason was provided for this even after I explained my situation. I was told my prescription would be flagged urgent and I can expect it to be processed the following day with a delivery date of Thursday, September 20th.
Without a choice for anything else I hung up the phone with the knowledge that my dose would be a day late. I am currently going through a Crohn’s flare which is worsened by stress and can have me hospitalized for weeks. I called Briova today (Wednesday, September 19, 2018) to check on my prescription. I was informed that nothing was done with my prescription and it was never sent to their pharmacist. I was given the same script about flagging my prescription urgent and how this is not their fault as the pharmacy required 72 hours to turn around a prescription.
The issue here is clear. Briova should have notified me weeks ago when my last prescription was filled. It is standard for a pharmacy to notify a patient that the medication they are receiving does not have any more refills. This allows a patient to contact their doctor to receive a new prescription while giving the pharmacy enough time to process it without causing stress or missed doses for the patient. Why does Briova not follow the same guidelines? Why was I notified 3 business days before my next dose if the pharmacy has a policy of 3 business days to process new prescriptions? Additionally, why is no one at Briova taking responsibility for not processing my prescription after I was told it would be processed? If I did not call to check on the prescription today, Briova would not have known they did not process a life-saving prescription.
I called Oxford United Healthcare to notify them that the specialty pharmacy they do sole business with is doing this to their patients. I doubt United Healthcare will take any action. It’s unfortunate because I have read multiple accounts of this occurring to other patients of United Healthcare and Briova. Multiple things need to happen to help all the sick people who depend on these drugs to keep them alive and healthy.
United Healthcare needs to take responsibility for the business relationships they have, especially if they will only use one company to fill their specialty drugs. Briova needs to update their system to one similar to every other pharmacy. Walgreens for example will text, call or email a patient within minutes if there is an issue with a prescription. It is unreal that a pharmacy can notify a patients days before their required dose that action is required from the patient or doctor, knowing that an earlier notification is possible during the previous refill processing.
I have spoken to both Briova and United Healthcare, but neither seem to care about this recurring issue or the patients they are forcing into this stressful and life-threatening issue. Even if United Healthcare chooses to overlook what is being done to their members, they should care about their bottom line. I can’t imagine it is better to force people into hospitalizations and ER visits due to this negligence. The costs alone should get the health insurance’s attention. I’m hoping this complaint will get to the decision makers of these businesses and initiate change.
I talked to a customer service rep three different times. Everyone seemed helpful on the phone but they have some serious issues following through. No one could give me a clear answer on why my prescription wasn't going through and I never received a call back like the rep said. They finally said my insurance no longer allowed my medication to be shipped through the mail because it's a controlled substance. This left me with questions because a month prior the same medication was shipped with Express Scripts. Recently while talking to a rep she said she would send over my prescription to a local pharmacy. It's now five days after the fact and the pharmacy said they never received a request. This all took 3 weeks. It's a terrible business model especially when they're messing with people's health.
When I call my prescription company I expect knowledgeable people to be handling my call. I certainly wouldn’t think this was too much to ask. I called to reorder a prescription for **, 20mg. today. Because my medications are unbelievably expensive I had already reached the limit where I am now in the donut hole for medications. My cost for this med was to be $432.00, which I could not afford to pay. I asked a simple question, “Is there a generic brand for **?” I waited while the representative checked with the pharmacy. He came back and told me the medication was **. I told him I would call back and order this after checking with my doctor.
A few minutes later I thought I would call back to see if there was a 10mg. tablet of **? The representative said there was and the cost for 90 days would be $67.00. I was very surprised at the difference in price between the 20mg. ($432) and the 10mg.($67). I asked him to tell me why the price was so different and he said he didn’t know but would transfer me to the pharmacy department. Once connected to the pharmacy, I asked the same question again and she said the cost for the 10mg. was $413. I asked how he could make such a mistake and she said it was a miscommunication. I then asked her about the generic that I was told of, **, and she said, “That’s a blood pressure medicines not a blood thinner.” At that point I was very upset that not only was I suggested an incorrect medication for my illness, I was given wrong pricing for the cost of the drug.
Again, she said this was a miscommunication and apologized. This was a potentially very serious communication error on OptumRx part! I asked to speak to a supervisor to relay what had happened. After being held on hold for a short period, a person named, tom, (he refused to give me his last name), told me that I asked for an alternative drug for ** and the representative did nothing wrong! HE DIDN’T HAVE ANY ANSWER FOR THE PRICING ERRORS. I’m taking this time to write this note as a warning to any person ordering drugs from OptumRx, the representatives answering the phones either are not well trained or the information available to them is very lacking. Since this company is owned by United Healthcare I would have expected better service.
It seems like most people in my office are experiencing their prescriptions being denied. Thank goodness we're not a prescription needing family. Two of my prescriptions were denied by this horrible company. It's now going on 1 month and my doctor said my levels are dropping, but gave me samples to hold me over. Only to find out that the samples are good but what if I need them for a period of time. She can't give me samples until the levels get to where they need to be. I never had this problem under my old plan but my company went with this crappy prescription company.
For the employees that work at OptumRx who dislike getting yelled at, I have a fun story to tell. You changed my meds to be a controlled substance without an email, phone call, or letter in the mail. Not knowing about this change I had to then rush order my meds (which means I had to pay an extra fee on already expensive meds). Nobody could explain to me why the meds changed. It took me TWO years to finally have a rep to tell me why I was no longer able to get my meds at my local pharmacy. Talk about stress. Stress causes seizures and those meds are suppose to control them. No meds means more seizures. Thanks Optum for "caring" about my health. The fun part of this story is that the post office lost it (and do so about every time) and when I called for help, nobody could do anything. I do get an email after they are delivered. Well, sort of. Meds got delivered on a Monday, Tuesday at 3am I get an email saying they were delivered.
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Checking my record OptumRx has a doctor listed that I have no idea who she is and she is NOT my doctor either. WHY! My prescription is denied each time because OptumRx system does not recognize my doctor's name because OptumRx has the wrong doctor listed on my record. It took OptumRx over 6 months to have the online system work for me. OptumRx claims that my record was transferred over from the other company but this is false. Why do I am charged more now for the same medication and all the problems I have to face for refills???
Every time, literally, every time my husband is expecting an 'automatic refill' there is a problem. Since I have had no problems, I initially blamed him, but after repeated episodes of trying to fix the problem (with me on the call), I have come to realize it is OptumRx. The newest REPEATED problem is that they are showing his insurance is not active. Our ins is thru UHC which they, on the phone, confirm THAT THEY OWN!! He checks his auto refill online-It's stuck-We place the order manually-. It's rejected-We call-they tell us the ins is not active-They force the ins to be active in the system, reset the order & the next time, the same thing happens ALL OVER AGAIN. They apologize repeatedly, say they will submit the issue to IT & explain they can't guarantee it will be fixed. RIDICULOUS! The RX is for high blood pressure which is being made worse by this INSANITY!
Problems accessing website, account not recognized after 2 years with company. No resolution on access for 3 weeks, no response email or calls about resolution. Renewals of ongoing prescription not being filled out, told filled already. No one to speak to other than customer service. Do not use them.
Prescription for **, a rescue inhaler for asthmatics, took 6 weeks to get to the correct address, even after verifying the correct mailing address with every phone call. It took a pharmacist, someone with a Pharm D. to get my address right. I was told one part of the computer system doesn't talk to the other which is why there was a mix-up. Took another 6 weeks for a different med. They initially weren't calling my primary number and when they started doing so after a few weeks, the automated system began speaking before my cell phone recorded, cutting off their company name and only leaving a phone number. Thinking it was a solicitor, I didn't call back right away.
Unfortunately, I was forced by my insurance company to used Optum under the threat of forfeiting medication payment coverage if I continued using my preferred pharmacy. With my final transaction, I ordered a medication where there is a quote on the Optum website for $70 for a 90 day supply. Optum charged me $70 for a 30 day supply. Since my local pharmacy only charged me $35 for a 30 day supply, I called Optum for an explanation. I was told that this is how my insurance company, Claim Central, set up this benefit and that I should ask them about this charge. Optum customer service transferred me to Claim Central but the automated system did not recognize my selections and I remained in an automated loop.
Feeling disgusted, I decided this wasn't worth the fight. I made multiple attempts to pay the $70 online. There was a problem with the Optum website so I called in and had a live person handle the transaction. Paying Optum money was the only easy interaction I experienced. There is more but I'm done. Hope someone reads the notes on my Optum account.
I had their automatic mail program shoved down my throat. I am on blood sugar, blood pressure and cholesterol medication. I get what I need on the last two but have 9 months excess on blood sugar. I called them to stop the blood sugar and they stopped everything. No choice - all or nothing so now I get nothing. There should be a law to allow us to use our local pharmacist and not have our medication sit for hours or days in 100 degree or more mailboxes.
I have been waiting three weeks for authorization for a medication. They did not contact my doctor because my doctor should "just know" it needs auth. There are hundreds of plans. There is no way they would "just know" it needs auth. I work in healthcare and we get notifications from insurance companies if a medication needs prior authorization. I have never not been notified. They kept blaming it on their policy. They either have a bad and dangerous policy in place or someone dropped the ball at the plan putting my health in jeopardy.
They completely ignored my request to not have my Rx filled, I NEEDED to get it from a pharmacy. Now they are refusing to cancel it and no one can confirm where it's being sent. 90 days of a controlled substance, so a HUGE deal if it's lost in the mail. Why would I worry that would happen? Because that's EXACTLY what they did last time. They sent it to the wrong address despite 3 calls from me trying to get them to PLEASE not send a controlled substance to an apartment I no longer live in. This company needs to be shut down. The services they claim to provide are too vital.
Every time I try to place an online order it is horrible (won't take sign on, page not working, error, etc). And when I call half the time the people can hear me so I have to call back till til they can.
Prescription coverage is a frustrating experience with this mercenary corporation whose goal is to deny that very prescription coverage retirees thought they were entitled to. Twice this year upon discharge from hospitals the prescriptions written by surgeons were denied dispensing by OptumRx. Their response is the MD has to fill out forms justifying the dispensing of a particular drug. Oh yeah, the Surgeon performing multiple operations daily is going to stop and jump to their tune? We have had this response shoved in our faces for every new prescription from our family doctors. They just say no prescription company knows that Doctors are not anxious to jump thru their hoops so the patient winds up paying out of pocket. Scumbags.
For over 1.5 years I have been unable to use their website to manage my prescriptions. First it was down for several months entirely. Then it came back online and now I can see my husband and daughter scripts (they have none) and can't access mine. Hours of time on the phone with their rep has done nothing to fix the issue and I gave up trying. I take 5 medications and it is hard to remember to call and order them.
Now, I'm dealing with an issue relating to a maintenance drug I can't stop taking. I am having trouble filling at their new retail partner. I made 3 phone calls and got 3 different answers (first two incorrect, still waiting on a call back for the 3rd) and I still don't have the medication I am now out of. Either way, this is not professional and an appropriate way to treat patients. It shouldn't take 3 days to place an order for a refill!
For the 3rd time, we have sent hard-copy prescriptions in with a note on the cover sheet they provide which has a specific line that says "Put these Rxs on hold on my profile. I do not need medication sent at this time". We always highlight this line and write a second note also stating that we don't want them to send any medication at this time. We will order it when we need it. Of course, they never pay any attention to these notes, and all they can say when you talk to a pharmacist who can see the scanned image of this cover sheet is "Sorry, I guess the data entry technician just missed the note". Does this mean they also don't enter any of the other information on the cover sheet, such as allergies, medical conditions, etc?
I am already out thousands of dollars out of pocket for my wife's prescriptions, which are not applied to my insurance deductible and maximum out of pocket, because OptumRx arbitrarily requires a pre-auth, arbitrarily denies the prescription, and then stalls and lies about the appeal process. This is with long-standing prescriptions (a matter of years), and the same medicines that were approved a prior month. Every month, something is denied. Even when the prescription has already gone through the pre-authorization process, been approved and the previous prescription filled.
You can go for weeks and months following their demands - the doctor has to contact them in writing, the doctor needs to write these specific words, and do it again and again when OptumRx claims that it didn't happen... And it's all smoke because at the end of that process, they'll tell you that it's out of their hands, the wrong process to begin with, and you need to contact United Health. Who will strenuously deny all knowledge or responsibility. If you ever do get it straightened out, heaven help you if the doctor prescribes 29 days instead of 30, or changes the date, because you'll be slapped with another "pre-auth" denial. As far as I'm concerned it's pure unadulterated fraud.
OptumRx holds your health hostage. They require you to buy 3 months of pills at a time, when many can barely afford 1. They requested a "reason" for birth control from my doctor, and would not fill until the doctor gave them a reason. You are unable to opt out of the mail order pharmacy. They leave your drugs outside on your porch through their mail service, a drug which you need a prescription for, is not open to thieves to grab by just taking it from your porch! Unbelievable. When I asked to opt out, they said that I could not opt out, and that I am required to purchase through them.
I called a number of times since January when OptumRx took over for Express Scripts (Very Bad Move). OptumRx can't manage to do what they are being Paid to do... So what is the point!!! Horizon Blue Cross and Blue Shield is paying OptumRX to make their customers very UNHAPPY... And helping them to be unhealthy. OptumRX STINKS at what they do!!!
OptumRx is having poor website and having lots of problem. I cannot even make online payment. Your order will suddenly disappear from order status. Customer service does not have any knowledge. They will just keep you rotating from one department to other. If you ask any question why I am not able to do this they simply say they do not know. If your medication is on hold they will not even inform you. I am really disappoint with their service.
Called to find out why I only received half of the number of tablets I ordered. Was told the order was filled for the amount prescribed by the doctor. However, the customer service representative did not have the correct formulary information. When I pointed out that my plan had a Bonus List she found the correct info. I asked why I did not get informed before the order was filled. I understand the order has to be filled as prescribed for the number of pills. However, I did not get an opportunity to cancel the order so I paid the full amount for half of what their website listed. The CS rep switched me to a supervisor who was very condescending when I tried to explain my situation. He told me "that is your problem". I will not use them in the future. Their website is misleading in my opinion.
I've just had my third prescription filled where OPTUMRX is my Medicare Prescription Drug Plan provider. This time my prescription costs are three (3) times what they were approximately 270 days ago! This is a plan that I was "placed into" by my teachers' group. My prescriptions are maintenance drugs, nothing esoteric. I've already started to do my research so that as soon as I can, I can get out of this plan. I get my prescriptions refilled at a CVS for the people who "mail in their prescriptions" are having horrible problems (some issues are life and death) for they have been mailed the WRONG medications!
Ridiculously high pricing which varies from day to day and service rep to service rep. Much wasted time trying to get the medication needed. Note to employers that provide this service as a benefit to their employees. Based on the service and pricing, employees will have a negative impression of the employer. Details below.
For 2 medications, Walmart charges $10 for 3 months, OptumRx charges $120 per month. Another medication that was prescribed "every 4 hours as needed" and, according to my doctor, if needed more than twice a week, the type of medication should be changed, i.e. under normal circumstances, it should not be taken more than twice per week.
When talking to the customer rep, I asked for one dispenser. I received 6 dispensers. According to the OptumRX rep, a pharmacist calculated that the medication would be taken every 4 hours (day or night) and sent enough medication (6 dispensers) to meet that calculated need for 90 days. The medication expires in Jan 2020, so the medication in 5 of the dispensers would expire before it could be used. During the first phone call to place the order, the cost of one dispenser was quoted at $46, the cost of the 6 dispensers was billed at $96. During the second phone call regarding the receipt of 6 dispensers when one was ordered, the service rep offered to sell 2 dispensers to me for $37 and I declined. The service rep agreed to send the paperwork necessary to return all 6 dispensers.
5 days later, I received a voicemail from someone claiming to be a pharmacist at OptumRX asking me to call and ask for a pharmacist. On the return call, the service rep asked me if I wanted to keep one of the dispensers at a cost of >$70. A total of 3 phone calls which took about 2 hours, 3 different prices, and the medication still needs to be returned and a credit made to my account. In addition, I'll need to source my medication somewhere else.
I have tried twice to get my prescription over to them and my doctor tried numerous times. Still they never somehow got them and sent me an email for fax. I faxed to them and only to be told that because I am not a doctor, my fax will be discarded anyway. This is one of the WORST companies I have experienced if not the worst. How can one company manage to be worst than a cable company? Mind boggling.
I feel better knowing I’m not alone. Horrible experience. Been trying to get my prescriptions to mail order and my doctor wasn’t responding because there weren’t any prescription listed in the request. I travel for work and trying to sort this out has been a nightmare between time zones and office hours and such. Evidently OptumRx is incapable of troubleshooting. Low hanging fruit if OptumRx has any desire at all to improve with more than marginal results. But likely there is no incentive to improve given how insurance works. Apparently, I’m not paying enough to include customer service as a benefit.
Have used OptumRx for years for med. prescriptions. A little rough in past but much better now. They are helpful, pleasant to work with, and caring. An occasional bump in the road, but rectified quickly. When receiving a prescription I receive numerous paper instructions. Ok, I get it but you should use both sides of paper. I don't read most of it. It's become redundant. I'm aware I can get that info online but frankly I don't want all that stuff sitting in my PC.
Most negative reviews are justified! I agree with - Scot of Rockwall, TX. OptumRx dispensed a recalled medication to me. My doctor submitted a new prescription. OptumRx is unable to fill the prescription. I checked with a local pharmacy. They would be able to refill the prescription. We asked OptumRx to transfer the prescription to the local pharmacy. OptumRx refused, hiding behind Nevada Regulations. “A prescription can not be transferred unless it has been filled, at least once, by OptumRx!” Result: I have a choice of taking contaminated medication, or do without. Conclusion: OptumRx does not care about the well-being of its customers! Think, several times, before using OptumRx.
OptumRx's website is nonfunctional. A rep admitted on the phone that it is not working properly. This has been going on for several months. I suggested that they add a message when the website is accessed that you may experience problems and may need to forego attempting to refill prescriptions online. No doubt that suggestion will not be passed upline or if it is it will be ignored. There is no excuse for a company of this size to allow its website to be unusable for months on end.
It’s been 7 months and the worst 7 months of dealing with a pharmacy company. Express Scripts rated an A+. Optum can’t be rated as there is no rating that exists below 1+. No communication and even the communication specialist can’t tell the truth. Read all the reviews and they all represent a poorly managed company. They agree supposed to deal with pharmaceuticals sent to patients. Hopefully they send out correct pills but not sure.
I am very disappointed with the way OptumRx handled my prescription for a maintenance medication that I need to take every day. I placed the order online and supplied all required information including my credit card number. They also had my email and phone number. More than 2 weeks later I received a snail mail saying they have been trying to reach me. However there were no voice mails and emails. After calling them i found out they needed to know my preference for generic vs branded. This information should have been asked upfront in the ordering process! How much more back and forth should I expect. Secondly their systems don't let me chose a shipping method so I am stuck with the standard delivery of 7 days. I really miss Express Scripts they were fantastic and also delivered in 2 days.
OptumRx (formerly Prescription Solutions) Company Information
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