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Click ‘Get Form’ to open the optumrx form in the editor.
Begin by completing Section 1, which is for member information. Fill in your Member ID Number, Last Name, First Name, Date of Birth, and Gender. Ensure you provide a valid Delivery Address and contact details.
Indicate any medication allergies and health conditions by checking the appropriate boxes. If you take over-the-counter or herbal medications regularly, list them in the designated area.
In Section 2, the prescribing physician will need to complete their information including their name, phone number, fax number, and address. They should also enter prescription details or attach an office prescription.
Finally, ensure that the physician signs and dates the form before faxing it to OptumRx at the provided number.
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To begin the PA process, you can: Let your doctor know that a PA is needed for your medication. Call Optum Rx at 1-844-368-8740. How long does it take for a PA to be approved or denied? Once your PA has been submitted and received, it usually takes up to 24 hours to process.
What is a DMR form?
Use the appropriate Direct Member Reimbursement (DMR) form below to submit a claim to be reimbursed for a prescription you paid out of pocket for at a non-participating pharmacy. For more information visit the Drug benefits and claims FAQs.
How do you use OptumRx?
Set up an online account at optumrx.com to help you manage your prescriptions Sign up to get your maintenance medication with home delivery. Find medications and lower cost alternatives covered by your plan. Set up text message alerts to remind you to take your medicine (Standard text and data rates may apply)
How do you get OptumRx?
Once your coverage begins on January 1, there are several ways to place a home delivery order: Go online to optumrx.com, download the Optum Rx app or contact Optum Rx by phone at 800-557-5785. Your doctor can send an electronic prescription to Optum Home Delivery.
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Use this form to request reimbursement for covered medications purchased at retail cost. Complete one form per member. Please print clearly. AdditionalRead more
This Member Handbook is also called the Combined Evidence of Coverage (EOC) and Disclosure Form. OptumRx, GCHPs pharmacy benefit manager: 1-855-297-2870.Read more
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