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Optumrx tier cost sharing request form

Optumrx tier cost sharing request form 2025

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The document is a Tier Cost Sharing Request Form for OptumRx, requiring detailed member and provider information, medication details, and clinical information to process requests for medication coverage. It emphasizes the necessity of complete information to avoid denial of requests and provides contact details for urgent inquiries. Additionally, it contains confidentiality notices regarding protected health information.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I get reimbursement from OptumRx?

File for a hassle-free claim reimbursement online Use our online form to request reimbursement for covered medications purchased at retail cost. Filing online is quick, easy, and results in faster response than filing by mail.

What are the tiers of OptumRx prescriptions?

generics and some brand name Use tier 1 drugs for the lowest out-of-pocket costs. preferred brand name Use tier 2 drugs instead of tier 3 to help reduce your out-of-pocket costs. brand name and some generics Many tier 3 drugs have lower-cost options in tier 1 or 2. Ask your doctor if they could work for you.

How do I request a formulary exception in OptumRx?

Your provider can start the exception process by completing a formulary exception request form and faxing it to 1-617-673-0988 . They can also call Provider Services at 1-800-708-4414. Call Member Services at 1-888-333-4742 (TTY: 711) if you have questions about the status of your exception request.

How do I request a prior authorization for OptumRx?

Optum Rx Pharmacy Helpdesk at (800) 788-7871 at the time they are filling the prescription for a one-time override. Optum Rx has partnered with CoverMyMeds to receive prior authorization requests, saving you time and often delivering real-time determinations.

How to get prior authorization for medication United Healthcare?

To have your doctor make a request Your doctor or provider can contact UnitedHealthcare at 1-800-711-4555 for the Prior Authorization department to submit a request. The plans decision on your request will be provided to you by telephone and/or mail.

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How do I get prior authorization for OptumRx medication?

For urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1028.

What is the phone number for Optum prior authorization?

To submit these requests, please contact our PA department at 1-800-711-4555.

How do I complete a prior authorization?

The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. Its best to confirm with the healthcare provider if they have the information and are willing to submit the request.