Consumer Complaints and Reviews
Can only get prescriptions through a very limited number of providers. Fine for big cities, smaller towns are limited and when nothing is open on a Sunday you have NO options. BIG issue and the reps don't even care!!! Poor customer service and even worse policies. Big insurance doesn't care about small town people.
I have had OptumRx since the first of the year. I am a dependent on my wife's CalPERS account. I have never been able to access the website. I have talked with 3 different system support people and have 2 different case numbers. Still no resolution. I needed refills for 3 regular prescriptions and had to call customer service. My account information was missing and had to have them re-enter it. When my order came, there was a balance due (I had a credit card number placed on file). When I called customer service to correct billing, my account information was missing again. Their excuse was that they just had a system update. Overall my impression is a totally incompetent operation.
On July 5, I was told by Edward that they would send me paperwork & envelope to return a prescription I did authorize to ship me. As a matter of fact, I was taken off this medication. I have sent numerous emails on 7/13 & 7/17 and still NO RESPONSE?
My doctor ordered two prescriptions and was told to send them to OptumRx. Instead they were sent to my local pharmacy. I contacted OptumRx about the problem, and was told that all I had to do was cancel the prescription at the pharmacy and OptumRx would then fill prescriptions because my record would show the prescriptions had not been filled. I did so but nothing happened on OptumRx's end, i.e., the web information still showed the prescription filled and not renewable until three months from now. So I sent OptumRx a hard copy of the prescriptions and my billing information. Still nothing happened. I called OptumRx last week and was told that, contrary to what I had been told in the first call, I had needed to call OptumRx after I cancelled the prescriptions at the pharmacy.
In the conversation the woman I talked to pulled up my records which showed that in fact the prescriptions had been cancelled about three weeks previously and that I had in fact sent in the prescriptions and billing information. She told me however that there was no mechanism in their system for them to figure all that out (even though she had it right in front of her) and that I should have known to call back in (the person telling me otherwise had been in error). The woman did help by filling the prescription and saying that they would send the prescriptions out express and the prescriptions should arrive on Tuesday (tomorrow). That night (last Thursday) I received a UPS shipment notice saying that a package was coming for me the next day--Friday (from an unknown sender). We were here all day and it did not come, but we received a notice that it had been delivered at 2:24 on Friday, which it had not.
On Saturday I went on the UPS website and found that it says clearly that if there is a package missing you need to call the sender to ask for a tracer, so I called OptumRx and was told, in a call lasting over half an hour, and one in which the woman I talked to said she had gone to her superior, that OptumRx would not contact UPS, that I should do so (even though I told her that UPS' website says to contact OptumRx and that I had no contractual relationship with UPS). If UPS could not find the package after 10 days, OptumRx would re-send the prescriptions. At this point it had been three weeks since the prescriptions were first sent to OptumRx. I called UPS who, after another half hour call (after she talked to her supervisor) said that I had to get OptumRx to make a claim, even though OptumRx had said it would not do so.
While I was irritated at UPS (since their driver clearly mis-delivered the package), I at least understood what their policy was. OptumRx, however, took no responsibility for the problem at any stage. It did not properly process my prescriptions and then refused to take any responsibility for the fact that they were not delivered, even though the UPS policy is clearly stated on the website (and presumably is part of any contract OptumRx has with UPS). OptumRx alone has a contract with UPS and the ability to get UPS to do something about a mis-delivery, which does happen. That OptumRx would do nothing to resolve a problem they created is, to put it mildly, incredibly irritating. It has clearly forgotten that it is supposed to be serving the customers. This is probably something of which AARP should take notice.
I have been with OptumRx for 6 months, and most of that time the website is down, sometimes for 4 weeks at a time! Their phone message says "manage your account online." WHAT?!?! Good luck signing in. Customer service, including the specialized web department is useless, doesn't know anything. Hope they go out of business. Was on the phone for 25 minutes today, nothing accomplished! Unprofessional, don't care!
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After spending hours in May to renew a prescription covered by CVS for years, OptimRx is denying the coverage. I will have to stand on my head to get this done. A repeat of 2 months ago. This has happened 4 times.
I requested an emergency supply of a particular prescription from OptumRx, a division of UnitedHealthcare, and had to try to do this multiple times, with multiple screw-ups by OptumRx. I re-ordered the drug I needed (at the appropriate re-order time) and clearly explained that I needed an expedited delivery, which the OptumRx representative agreed to. Now I find out that the drug ordered was NOT expedited and I will not receive the ordered expedited drug for another week. It's time to change prescription drug suppliers!!! Goodbye OptumRx and UnitedHealthcare.
I went on to their online site and put in a refill order. It showed up online as in process. My doctor's office called to tell me that the OptumRx had called and that my doctor had given them authorization for a refill on June 21, 2017. On June 29 The online site still read in process. I called and spoke with a representative who stated they did not have the correct credit card information. I rechecked the information they had and it was the current credit card. I explained I only have three more days of medication left. I was reassured that it be shipped overnight express and I would receive it on June 31. I told him there are only 30 days in June, he then said I would get it on May 1. What? He then changed it to July 1. July 1 came and went still no medication.
I called on Sunday, July 2. I was told they were still waiting for authorization from my doctor. They told me to have my local pharmacy call them and they would give them authorization for two weeks emergency refill. I called my local pharmacy and he said "no, this was not legal since we actually did not have a current doctor's order." Today is July 6. I have called OptimumRX every day for one week. I talked to a different person each time. I leave comments after my calls per their request but still no one has returned my calls or figured the problem out.
I have spoken with representatives, two different pharmacist and today a supervisor. They have no record of me calling and talking to any of this people. However, she did find a note stating that they were back ordered on the medication and that's why it was being delayed!!! Truly, the left-hand does not know what the right hand is doing with this company. This company is supposed to be managing senior citizens medications? This is scary! My advice stay with your local pharmacy, even if it's going to cost a couple more bucks!!!
Before getting sick I wrote code at a major hospital to process all the data from all the systems and send the info in HIPAA require format to insurance companies to bill. So I know the system and rules. It also means I dealt with lots of health plans. After Blue Cross became obscenely expensive I switched to AARP as they have a good rep. AARP uses United Healthcare actually. For several years I had no issues.
Then they switched to having Optum Rx not be just a mail order pharmacy but to use them as a third party clearinghouse. Meaning United Health Care contracted all approvals, pre-auths, billing and everything to them. Since this happened it's a nightmare. I constantly get prescriptions denied even though they are in formulary and I used for 10 years cause they think they know better than my doctor how to manage my extremely complicated care that is 15+ different meds including iv infusions and shots.
Many items they only allow you to get 24 hrs before you are out at most 4 days. It a constant fight with them. Even when I can show cost savings by using a certain medication. I get told no. Most companies like saving money. So I take 3 meds that don't work as well as what I want and it costs them double. Often I end paying out of pocket and getting reimbursement cause I don't have time to wait. There are some meds I just pay for cause they won't cover. I use GOODRX as often as them. I cannot wait to switch.
Now in fairness not all problems are theirs. Recently due to over prescribing drugs the state and federal system has added a lot of rules aimed to fix the issues especially to CII and CIII drugs. Optum is using these rules and stretching these rules to try to avoid paying claims. My advice change your insurance. Know the rules and your rights. Fight for your meds (50% of meds are approved on first stage of appeal). Appeal, take them to the mat on it.
Be annoying often. I find insurance will approve stuff and hurry along just not to have to deal with you. I will call them every day and sometimes hourly to check on status and push a claim through. Get the name of who you talked to and nag that person, phone, fax and email. Once they know you aren't going away know your rights and will press the issue they often give in. Appeal, run it through every level of appeal, go to Medicare if needed. Know how long each level is allowed to take. If they get 72 hours at 72 hours and 1 minute call them, inform them they are breaking the law. Report them to Medicare if they do break the law. A plan must meet certain criteria if they get to many complaints Medicare will cancel that plan.
These places want to make money. The less claims they pay the more they make. No health plan wants to treat patients, it's expensive. So to get what you need learn the rules. Stay calm, don't yell. Use the rules, be an informed consumer. Fight for what you need, use the system along with constant follow ups. They may be a lion and you are a mouse but you can put a thorn in their paw and the only way to remove the thorn is by helping you. Hope this helps.
Just reading all of the issues further confirms my recent dealing with this company. Retired and now using this insurance as of April. I have never made so many calls to an insurance for prescriptions. Each time getting very rude people and getting inconsistent information. My doctor's office even had to make numerous calls as the information given was never correct or consistent. My latest issue is paying full price for a generic drug - the same price as the name brand. Other calls gave me pricing ranging from $37 to zero. Now I'm at $187 for a generic. Doesn't make sense.
OptumRx is terrible. They auto shipped and charged for 9 bottles of eye drops in 5 months during which time I could only use 2 bottles, and then 4 bottles of eye drops in 3 months when I could only use 1. I had to call 3 separate times asking to be dis-enrolled from the OptumRx Hassle-Free program before it finally took effect. The OptumRx Hassle Free program seems to be program designed to maximize profits for OptumRx rather than a helpful service for consumers. The strategy appears to be "ship more products than required, bill the insurance company for excess shipments, and hope the consumer doesn't complain since the insurance company is paying." This is good example why healthcare costs continue to rise.
I rarely write reviews but this has been an awful experience. In the past when I have received medication it was the same brand consistently. I have received 2 refills of an anti-depressant recently and each time it was different. I expected the first change because I went from my pharmacy to OptumRX. The second manufacturer change was not communicated to me. This new prescription was delayed because of a billing error with little sympathy from the company that someone could be put into withdrawal without these meds. This new medication is NOT working and they cannot return me to a different one. Per the pharmacist "manufacturers can't be guaranteed because we buy in a large scale so they're subject to change".
If you look up this particular medication there is a long history of problems with bio-equivalence between generics and even minor changes that still get FDA approval can impact a person's reaction. I was told I needed to contact my local pharmacy and that there was nothing they could do on their end to resolve the problem besides sending me a return label to mail it back. HORRIBLE patient care. My insurance changes next month and I will be glad to never deal with this again.
I am a CRNP in the state of Pennsylvania. I absolutely cannot get prescriptive authority without a collaborating physician. We must have this Collaborative Agreement on file at our workplace as well as Harrisburg. OptumRX is the only prescription plan that requires written documentation of collaborating physician and NPI number to process a refill. This adds another layer of phone calls/faxes and delays for the patient. Sometimes this information will be solicited by phone, then a fax is sent. Ultimately the company requests a new RX. This can provoke another round of phone/fax requests for collaborating physician info.
Attempted to manage my mother's prescriptions and the company was impossible to deal with. I spent 2 hours trying to get through the voice mail system and on hold, then when I got a human, she did not help me and actually hung up without helping me. I had to start over, and then I couldn't get through at all. I don't think they want to be accessible to their customers by phone.
Last year I paid an alleged overdue balance from the year before. I needed my meds and had made some changes in my bank so maybe something didn't go through so I paid and moved on. Today I call and get the exact same story that balance from September of last year had to be paid. I've paid my copay numerous times since then with no problem, no one has tried to contact me about paying anything or spoken to me about them possibly holding my meds if it wasn't paid. I have no problem paying for something I owe but I have spoken to customer care on the phone too many times and not once have they told me I owed any money.
Now that I'm almost out of insulin and trying to see why they haven't shipped it I'm finding out. This is very poor business and I really dislike this company. They need to rethink how they do business. It's very bad that they wait until I need my medicine to tell me about this. It's almost been a year, there were plenty of chances for them to inform me, send an email or something.
I've used OptumRx for over a year and have had no problems. Aside from having 0 copays for my meds, it saves me, a disabled veteran, from having to go to a pharmacy. I do wish they would automate the refill process. But they have done exactly as they promised.
I would rather and I have paid full price for prescription at times rather than deal with this horrible unorganized pathetic company. I have epilepsy and they have "claim" after "claim" said they sent when in fact they never did and later after a hospital stay called to apologize they apparently found my misplaced paperwork. This has happened several times with almost every prescription. They in accidentally charge my card over and over.
OptumRx is DISGRACE!! They have wasted hours of my time and I have no medicine. Look at all the complaints on here! Medicare needs to take action to shut this disgrace incompetent garbage down. It is causing harm and senseless suffering to millions of people who need their medicine and they just give excuses and lose your info and waste your time and never send the medicine. Instead of calling and transferring a pharmacy prescription like every other normal company they won't do it and make you get a new one and never follow up and it never works. I have tried and tried and they won't do what they say they are suppose to be doing. This so called company are making sick people sicker and a HORRIBLE DISGRACE. Let this warn anyone else from even starting with them. You will regret it, believe me!! This so called company is HORROR and NEEDS TO BE SHUT DOWN!
I absolutely HATE this pharmacy company, but I have no other choice for my monthly medicines. I have been on the same medications for almost 20 years. For twenty years, I have had a 3-month supply delivered to my door... no signature required... no set of questions to go through each and every time. Now with Briova, EVERY SINGLE MONTH is it something different. Some months they will deliver with no signature required. Other months they refuse, so I have to have the shipment redirected. They will not allow me to keep that information on file. I am no longer able to order a 3-month supply... only month at a time. Sometimes my meds are listed on my list online. Sometimes they are not. Sometimes I have to call. Sometimes I don't.
This company is a piece of **! Can we please reform our system so I can just go to the pharmacy that is 5 blocks away from my home??! And why in the world do you need to put two tiny bottles into a HUGE cardboard box every month?? I feel guilty throwing them out, but I just tell myself that it is Briova that doesn't care about the environment, not me!
Consistently they fail to deliver maintenance meds when they are needed. It's weeks between when we are out of a drug and when we get it. We order well before it's needed. So we go without required meds for extended periods of time because they are having too much true getting their act together for over a year! Unacceptable!!
The people at OptumRx are courteous and professional but the company is poorly managed. I'm quite sure I could do a better job. I've run companies before and this one needs a TON of fixes!!! Not only don't they do their job, but they actually make my life/job much harder!!! I am irate at the boneheads at GE who thought OptumRx would be better than Caremark. Every month I've had to fight with this company. Here's why: They never check in on me. “How are you? Any symptoms? How are the meds doing?” Like my last pharmacy did. They don’t call to ask if I'm ready for my next refill, like my last pharmacy did. That's up to me now. Why can someone write a simple program that knows when we need to take action?
A cheap program could schedule and make a robocall and/or send out a text or email to help give us their customers a heads up?? Is that so hard?? They let my co-pay coupon expire and don’t find us new coupons to save us copays $$, like my last pharmacy did. Apparently I need to get my doc to renew my Rx!!!! They told me I should call them each month to see if there's anything I CAN GET FOR THEM!!!! This was THE most egregious. If they want the business and all the CASH$$ they're making off us, why aren't THEY calling to keep us from a break in care??? Like my last pharmacy did. When they need a prior authorization, why don't THEY track down my doctor like Upstate Pharmacy does?? Do they now have the correct contact information for next year? Or will this happen next year? I say… yikes. Their track record sucks.
They threatened to halt my Rx twice because "Your doctor hasn't responded to our letter". I called my doc and they never got any letter. Really???? One letter is the best Optum can do? Then it's "Too bad for you". Forget that the meds I take keep me alive. I'm not taking allergy meds. My doctor was furious. They needed a pre-auth for 2 of my meds that I’ve been taking for years and threatened they may not be approved. My last two pharmacies NEVER did this. I've NEVER had a problem. Optum explained that what I was taking was excessive. Yeah!!! It sucks for me, but these meds have gradually been increasing over the last 17 years!!! My doc says she's surprised I've been able to keep my doses down so LOW for so LONG. The employees need sensitivity training. They have to realize that many of their customers are ALIVE and can contribute to society because of the meds.
For me, 2 of my meds actually allow me to get out of bed and do stuff without pain. The other keeps me alive from a mystery blood condition. It's like the whole company second guesses the doctors. Maybe if they had more information about their patients, they wouldn't have to accuse us of wrongdoing. I've soooo had it with this company and I'm on a rampage to find the GE decision maker who switched us. I would like an override to use my former LOCAL pharmacy who know me AND KNOW my doctors. That's accountability!
This company is nothing but a fraudulent, blackmailing swindler. I have AARP prescription plan, meaning United Healthcare. Never had any problems. Suddenly my prescriptions are being denied by this company, Optum, because I am exceeding my MED limit. This just started last month. I called Optum and asked, "What's a MED limit?" and "Who are you?" Lie 1) it's a new LAW passed in March that limits pain meds! There was no new LAW, it is a scale that physicians can follow. Lie 2) they are a company authorized to enforce the new limits.
Ok, my Doctor, a very honorable, careful, decent, educated for pain management, anesthesia specialist, called last month and authorized raising my MED limit so that I could pick up my medicine. I see him once a month. Optum did it again this month. There was a small change in my medication. I had to have him call this company once again to raise my limit. It wasn't really a change, it was because I was given a full month supply because we changed my medication last month and until we knew if the new doses helped, and I am happy to say they have. So I called Optum, asked them to stay out of my business. Called United Healthcare also and asked them why Optum is involved when for 15 years there has NEVER BEEN A PROBLEM. They agreed and said if Optum gives me more problems to just call them.
Here is the really crazy part: When I called Optum back THEY ACTUALLY SAID THAT IF I USED THEM AS MY PHARMACY THERE WOULD NEVER BE A PROBLEM!!! I could not believe what I had just heard. I asked him to repeat that. I wish I could legally record telephone conversations without the other party's permission. Unbelievable!!! They are nothing more than a scam and tried to blackmail me. Who do I report them to? The FDA I suppose.
I was charged three times for a prescription in April 2017. My credit card noticed and refunded two of those charges, meaning Optum still received the correct payment one time. In the past 10 days, I have made three phone calls and faxed the portion of my credit card statement that proves these charges. As of yet, it still hasn't been resolved. The account rep told me this morning that I need to give them time to verify all of this. I explained to him that this was their error in the first place but he made no apology. I should not have to spend this amount of time correcting THEIR error.
On or about 5/25/2017, I called OptumRX to get a price on ** 5% Cream. They gave me a price of $167.67 for a 90 day supply, but when my doctor called it in on 6/9/2017, the cost is $275.00. That is $107.33 increase in 15 days. I call that price gouging.
Terrible place. Optum tries getting out of paying claims by bogging you down with bureaucracy. When your Dr. calls to straighten things out OptumRX conveniently loses the paperwork and claim the Dr. never sent it. Why does United Health Care choose OptumRX as their online pharmacy of choice!!! Because it is cheap for United Health Care to do so rather than using a quality company.
I never write reviews but I feel the need to share my experience with OptumRx so that it may help other people out in the future. I signed up on home delivery with OptumRx online for my medication, not knowing they were going to ship my product as soon as I signed up for it. I didn't realize my medication was no longer covered, so I called their customer service number to set up a return for a refund (keep in mind I did not open the package to my medication or break the seal). They told me because I ordered online instead of calling and placing the order through them, they could not issue a refund. This made me upset but I didn't attempt to pursue it further. I went online and immediately canceled the home delivery service.
A month later, I see that I'm totally in debt from a charge. I called OptumRx back and explained that I cancelled out all services (did not get a confirmation email) and still got charged for the prescription that they sent out. I asked to have it returned for a refund because I no longer needed the medication and I was in debt because of it. After the 2nd call, the call agent finally set up a request to have a return package sent to my house. I asked him to send it to my current address (as the one on file was old). I was assured I would receive it in the mail in 5-7 business days. It took a little longer than that, which is no problem, but they sent it to the wrong address even though I confirmed the new address with the company.
I called them back to have the return package resent to my right address and they told me they would make it critical priority. Days go by and I never received a tracking number for my new shipment. I call them back to find out that they never even put a request in to have it resent. Doing business with this company has been nothing but problems after problems. I don't recommend this company to anybody.
I am so dissatisfied with OptumRx AARP MedicareRx Preferred. I called in to get my prescription ordered and the lady told me it would be $90.00. Well when I received the order it was for $389.42. I was not happy and called them about this. They were no help to me at all. I will not chose this company ever again and will tell everyone I know how awful they are. They do not even deserve a rate of 1.
The OptumRx website has not been working for over a month. I am having difficulty managing the many prescription I take without this site. Their website was one of the reasons I chose OptumRx - But now it doesn't work. Have complained to them several times, but nobody seems to care.
This company has shockingly disorganized billing practices, and will cancel your order without telling you if they (incorrectly) decide you have a balance. They also lie, saying I didn't pay in a month when my credit was charged. If you try to resolve the issue, they either put you on hold and never pick up from the hold or drop the call. I am forced to use them, I hope you are not.
I guess you pay a price for convenience. One rep told me the manufacturer stopped making an Rx at 100 mg, so if I could wait, they could see if they could still get it at a lower dosage. Heard nothing, so I emailed. No phone call, no email returned. So I called again. This rep, who I could barely understand, just said the manufacturer stopped making it. I explained that they were supposed to then send me the Rx at the lower dosage. Now, she says, there are no refills. I said, I never got the first refill. She says, "We will need to call your doctor for a new refill." They now have no record of my ever having had this Rx and I have had it for five years. No order number, nothing. I finally gave up. Good thing, it is not a life sustaining Rx.
Updated on 06/12/2017: No one will talk to me when I call. I get hung up on. My Dr state that he did not tell OptumRX to cancel the prescription and for them to call him. I can't get through and there is no agency to help me.
Jonathan TroutConsumerAffairs Research Team
As a member of the ConsumerAffairs Research Team, Jonathan Trout believes having access to free, comprehensive information on products and businesses is vital to making smart purchasing decisions. He focuses his efforts on researching and reviewing multiple brands across a variety of industries, with the goal of writing unbiased buyers guides to help inform consumers on impending purchases.
OptumRx is a healthcare management company that offers pharmacy benefit management solutions to organizations across the healthcare industry. Their pharmacy solutions include home delivery services, member engagement, pharmacy management and specialty pharmacy management.
- Member engagement: OptumRx focuses on educating its members through personalized tools and 24/7 support. Their mobile application lets members refill or renew home delivery prescriptions, locate a pharmacy and find generic drug prices and discounted prices. OptumRx also gives its members the option to receive text messages to remind them when to take their medications.
- OptumRx home delivery: The OptumRx home delivery service includes free standard delivery to United States addresses and territories. New prescriptions will arrive within 10 business days, while refills will arrive within seven business days. Members can create accounts with OptumRx, select their medications and place orders. OptumRx will contact primary care doctors and licensed medical professionals for approval as needed.
- Pharmacy benefit management: OptumRx pharmacy benefit management solutions focus on optimizing its members’ health through monitoring and engagement. It teaches members about safe medication use and cost-effective treatment options.
- Specialty pharmacy management: OptumRx helps specialty pharmacies by identifying trends in specialty care and creating clinical programs to help alleviate costs. Their website includes resources on specialty conditions, one-on-one video consultations with pharmacists and information on how to increase adherence to specialty drugs.
- Accreditation: OptumRx holds multiple accreditations with URAC, including one for specialty pharmacy services, pharmacy benefit management and drug therapy management. They are also accredited by VIPPS and the NABP.
- Best for organizations needing pharmacy benefit management solutions.
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OptumRx (formerly Prescription Solutions) Company Profile
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