the right medication
at the right time
for the right duration
and at the most appropriate cost
The Optum Pharmacy Care Services solution is designed exclusively for workers’ compensation and auto no-fault claims. Our pharmacy care services applies clinical expertise, analytical tools and industry knowledge to deliver proven solutions for cost containment and forecasting.
Our comprehensive solution addresses key challenges that drive pharmacy spend, in-network transactions, unit cost, utilization, administrative costs, compliance and service quality.
Nearly 60,000 network pharmacies makes filling prescriptions in-network quick and easy.
Our retail pharmacy service provides unparalleled access to nearly 60,000 outlets nationwide. With Optum your claimants will have simple access to their prescriptions, while you will keep more transactions in-network, reduce your administrative burden, and:
Identify utilization, cost control issues, high- & low-performing providers
Drive program performance with measurable outcomes
Identify and execute resolution management for issues
SIMPLIFY PHARMACY TRANSACTIONS UPON THE FIRST FILL
Upon verification of eligibility, Optum provides each injured party a retail pharmacy card attached to an informational letter. The letter introduces injured parties to pharmacy care services, network pharmacy access, a listing of nearby pharmacies and medication safety information. All standard letters are produced in English with a Spanish translation on the back.
Virtual pharmacy cards list all necessary information for an injured party to present to a pharmacy in order to process their prescription(s). The cards can be downloaded for printing or sent to an email or mobile device.
First-fill cards are available through employer human resource departments, claims adjusters/clinicians, and First Report of Injury coordinators, they ensure that pharmacies can dispense an injured person's initial prescription with ease.
Home delivery can provide significant cost savings as prescriptions are filled at higher discount rates and generic substitutions are made where permitted. When appropriate, claimants can also take advantage of a 90-day supply option.
Instant activation ensures easy access for injured parties to receive the prescriptions they need when they do not have a pharmacy card. With instant activation, claims professionals can provide the pharmacy with the necessary info to process an injured person's prescription(s).