clinical expertise, analytical tools and industry knowledge drive positive results
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.
ACCESS TO nearly 70,000 retail pharmacies nationwide
Our retail pharmacy service provides unparalleled access to nearly 70,000 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:
Drive program performance with measurable outcomes
Identify utilization & cost control issues & high- & low-performing providers
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.
- 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).
- Virtual pharmacy cards list all necessary information for an injured party to present to a pharmacy in order to process a prescription. They 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.
- Pharmacy locator is available on-line to all injured persons, as well as client representatives to look up and search for participating network pharmacies based on name, region or location.
- 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.