Optumrx reimbursement online 2026

1. Click ‘Get Form’ to open the optumrx reimbursement request form in the editor.
2. Begin by filling out the Member Information section. Enter your Member ID, Health Plan Name, Group/Employer Name, and Health Plan State. Provide your Last Name, First Name, Middle Initial, Mailing Address, City, State, ZIP Code, Date of Birth, and Gender.
3. In the Physician and Pharmacy Information section, input the Prescribing Physician's Name and Phone Number along with the Dispensing Pharmacy's Name and Phone Number.
4. Select the appropriate reason for your reimbursement request from the options provided. Ensure you check all that apply to your situation.
5. Complete the Acknowledgement section by certifying that all information is accurate. Sign and date where indicated.
6. Attach any required pharmacy receipts as specified in Section A. Make sure they contain all necessary details for processing your claim.
7. Review all sections for completeness before submitting your form to OptumRx Claims Department at the provided address.

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