What OptumRx is and who uses it
OptumRx is a mail-order pharmacy owned by UnitedHealth Group. It fills prescriptions by mail for people whose health insurance includes OptumRx as their pharmacy benefit, or for people who choose to use it outside their insurance. You receive medications at home instead of picking them up at a retail pharmacy location.
OptumRx serves people with commercial health insurance, Medicare Advantage plans, and self-insured employer plans. Some people also use OptumRx without insurance by paying out of pocket. The service is available in all 50 states.
Mail-order pharmacies like OptumRx are most useful for medications you take regularly — blood pressure pills, diabetes medications, cholesterol drugs, or any prescription you refill monthly or every few months. They are less practical for antibiotics or other short-term medications you need quickly.
Key Takeaways
- OptumRx fills prescriptions by mail for people with UnitedHealth insurance plans or those paying out of pocket, with delivery typically taking 7 to 10 business days.
- You can order through the OptumRx website, mobile app, phone, or by mail, and most plans allow 90-day supplies at a lower cost per dose than 30-day retail fills.
- Your copay or coinsurance depends on your specific insurance plan, and OptumRx will tell you the cost before you complete an order.
- OptumRx maintains a formulary — a list of covered medications — that varies by insurance plan, so your plan document or OptumRx directly can tell you what is covered.
- If OptumRx does not stock a medication or your insurance does not cover it, you can request an exception or use a retail pharmacy instead.
How to place an order with OptumRx
You can order from OptumRx in four ways: through their website at optumrx.com, through their mobile app, by phone at 1-855-839-6746, or by mailing a paper prescription form. Most people use the website or app because you can see your cost and delivery date before confirming the order.
To order online, you will need to register an account with your name, date of birth, and insurance information. You can then upload a prescription image, have your doctor send it electronically, or transfer a prescription from another pharmacy. OptumRx will show you the copay amount and estimated delivery date before you submit the order.
If you are a new customer, OptumRx may ask you to provide your insurance card or Medicare information to verify coverage. This usually takes a few minutes. If you pay without insurance, you will see the retail price and can choose whether to proceed.
Delivery times and how long medications last
OptumRx typically delivers prescriptions within 7 to 10 business days of order placement. Delivery time depends on your location and the medication — some drugs require special handling or are in higher demand. You can track your order through the website or app once it ships.
Most mail-order orders are for a 90-day supply, which is three times the amount of a typical 30-day retail fill. A 90-day supply costs less per dose than buying three separate 30-day fills at a retail pharmacy, which is why many insurance plans encourage mail-order use for maintenance medications. Some plans require mail-order for certain drugs or charge a higher copay if you use retail instead.
OptumRx can also fill 30-day supplies if your plan covers them or if you request a smaller amount. You can set up automatic refills so medications arrive before you run out, or you can order each time manually.
Cost and insurance coverage
Your cost for an OptumRx prescription depends entirely on your insurance plan. If your plan includes OptumRx as the mail-order pharmacy, your copay or coinsurance will be the same as what your plan document states. OptumRx will show you the exact amount before you complete the order.
If you do not have insurance or your plan does not cover a specific medication, OptumRx offers a discount program called OptumRx Savings. You can look up a medication on their website to see the cash price. Prices vary widely by drug and strength — some common medications cost $10 to $30 for a 90-day supply, while others cost much more.
Some medications require prior authorization, meaning your doctor must get approval from your insurance plan before OptumRx can fill it. OptumRx handles this request on your behalf, but it can add a few days to the process. Your doctor's office can also request authorization directly.
What medications OptumRx covers
OptumRx maintains a formulary — a list of medications covered by your insurance plan. The formulary changes by plan and by year. You can view your plan's formulary on the OptumRx website by entering your insurance information, or you can call OptumRx to ask whether a specific medication is covered.
If a medication is not on your plan's formulary, you have a few options. You can ask your doctor to prescribe a different medication that is covered. You can request a formulary exception, which asks your insurance plan to cover the drug anyway — this requires your doctor's support and takes several business days. Or you can pay out of pocket at the OptumRx cash price or use a retail pharmacy instead.
Some medications are covered only if you try a cheaper alternative first — a practice called step therapy. For example, your plan might cover a generic blood pressure medication before covering a brand-name version. OptumRx will tell you if step therapy applies when you try to order.
Refills and managing your account
You can refill a prescription through the OptumRx website, app, or phone. If you set up automatic refills, OptumRx will send your medication before you run out — usually 14 days before your current supply ends. You can pause or cancel automatic refills anytime through your account.
Your OptumRx account shows your order history, current prescriptions, delivery status, and saved payment methods. You can update your address, phone number, and insurance information in your account settings. If you move or change insurance, update your account so future orders go to the right place.
If you need to speak with a pharmacist, OptumRx offers phone support during business hours. You can also use the app or website to message your pharmacist with questions about medications or side effects.
When OptumRx may not be the right choice
Mail-order pharmacy is slower than retail, so it does not work well for urgent medications. If you need an antibiotic or pain medication right away, a retail pharmacy is faster. OptumRx is designed for medications you take regularly and can plan ahead for.
If your insurance plan does not include OptumRx, you may pay more to use it than to use your plan's preferred pharmacy. Check your insurance plan document to see which pharmacies are in-network. If OptumRx is out-of-network for you, using it will cost more or may not be covered at all.
Some people prefer retail pharmacy because they like speaking face-to-face with a pharmacist, want to pick up medication the same day, or need to adjust doses frequently. These are valid reasons to use retail instead, even if your plan covers OptumRx.
Frequently Asked Questions
Can I use OptumRx if I have Medicare?
Yes, if your Medicare Advantage plan includes OptumRx as a pharmacy benefit. Original Medicare does not include OptumRx directly, but you can use OptumRx as a retail customer and pay the cash price. Check your Medicare Advantage plan document to see if OptumRx is covered.
What happens if OptumRx does not have my medication in stock?
OptumRx will contact you to let you know the medication is temporarily out of stock and give you an updated delivery date. You can also ask to fill the prescription at a retail pharmacy instead while you wait. If the delay is too long, your doctor can send the prescription elsewhere.
Can I transfer a prescription from my retail pharmacy to OptumRx?
Yes. You can authorize OptumRx to request the prescription from your retail pharmacy, or you can ask your retail pharmacy to send it to OptumRx directly. This usually takes one business day. You can also ask your doctor to send a new prescription to OptumRx.
What if I do not want to use OptumRx even though my plan covers it?
You can use a retail pharmacy instead. Check your plan document to see if you will pay a higher copay at retail. Some plans charge the same copay at any in-network pharmacy, while others charge more for retail. You can always call your insurance plan to ask what you will pay.
How do I know if a medication requires prior authorization?
OptumRx will tell you when you try to order if prior authorization is needed. Your doctor will receive a request and can approve it through their electronic system, usually within one business day. OptumRx will notify you once authorization is approved and your order can proceed.