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Submitting prior authorizations via ePA (electronic prior authorization) is the fastest and most convenient method for submitting prior authorizations. ePA can save time for you and your staff, leaving more time to focus on patient care.
Your plan has three copay tiers. Tier 1 has mostly generic medications and has the lowest copay. Tier 2 has mostly name brand medications and has a higher copay than Tier 1. Tier 3 is mostly name brand, non-formulary medications and has the highest copay.
Who is OptumRx? OptumRx is your CalPERS pharmacy benefit manager for Anthem, Health Net, Sharp, UnitedHealthcare, and Western Health Advantage. Our goal is to provide safe, easy and cost-effective ways for you to get the medication you need.
Wegovy has been excluded on the OptumRx Premium Formulary via the New Drugs to Market Exclusions list and has been placed on Tier 3 of the OptumRx Select Formulary until the drug is further evaluated by the OptumRx National Pharmacy Therapeutics Committee.
optum.com/optumrx Mounjaro will be available as 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg per 0.5 mL single-dose pens.
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People also ask

Today more than 70% of people who use Optum Rx already pay less than $35 per month on insulin. Effective Jan. 1, 2024, thanks to the latest actions by Optum Rx, 98% of all Optum Rx consumers will have access to insulin for $35 or less per month.
Its important to note that prescription drugs cost less with the Optum Rx pharmacy benefit compared with online cash discount retailer pricing nearly 90% of the time.
Price Edge scans available prices and automatically provides the lowest available pricing to the member. If there is a lower cost to the member outside of their insurance benefit, Price Edge automatically applies that price.
Sometimes the patients health plan may require a prior authorization (PA) before covering Mounjaro. It is important to provide the correct information to ensure there are no delays in treatment.
Optum Rx positioned the tool as an enhancement of the companys ability to offer a lower price on generics at about a 90% rate. Price Edge, the company said, ensures competitive consumer prices on generics by scanning available prices and automatically providing the lowest available pricing to the member.

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