OptumRx Response to Novel Coronavirus (COVID-19)

Updated 4.14.2020

Tuesday, April 14, 2020
OptumRx Communication: Formulary Changes for Albuterol Inhalers 

Due to the COVID-19 pandemic, there has been a surge in prescriptions for albuterol inhalers leading to an acute shortage in some areas.  Manufacturers continue to produce albuterol inhalers but are struggling to keep up with the demand and some pharmacies are unable to fill member prescriptions with the preferred formulary alternatives.   

To address the situation, OptumRx is temporarily changing formulary status of non-formulary albuterol products, both brands (Proventil®, Ventolin®, ProAir®) and authorized brand alternatives, to facilitate member access to a broader array of albuterol-containing products. These actions will also apply to levalbuterol products (Xopenenx® and generics).  

Effective April 10, 2020 

  • Excluded albuterol and levalbuterol brand products will be covered in Tier 3. 
  • Excluded albuterol and levalbuterol generic products will be covered in Tier 1. 
  • Step therapy requirements for all albuterol and levalbuteral products on the OptumRx Select formulary will be removed.     

OptumRx will also delay the 7/1 albuterol exclusions for an indefinite period of time due to the supply shortage. All planned member letters communicating the exclusions have been suppressed.   

OptumRx will continue to monitor the supply chain for albuterol medications and will move forward with the formulary changes once supply and access issues are resolved. 

Monday, April 13, 2020
OptumRx COVID-19 Policy Update: Network Access Override

OptumRx is implementing a new component to their COVID-19 Response Policy to support members in accessing their medications during this time. This policy was effective on April 13, 2020.

Policy Details:

  • OptumRx will provide a one-time network pharmacy override (prevent out of network rejection messaging) to access an out-of-network pharmacy upon pharmacy request when:
    • an out-of-network pharmacy has stock of a covered prescription medication that is in short supply at a network pharmacy,
    • an out-of-network pharmacy is in closer proximity than a network pharmacy to a member’s residence, as reported by the member, or
    • an out-of-network pharmacy has capability to mail/deliver to the member’s home that is not provided by a network pharmacy.
  • The ability to offer out-of-network pharmacy network overrides will remain in effect for 90 days from April 13, 2020, and re-evaluated for extension thereafter.
  • Specialty networks are not in scope for this policy.

Monday, March 30, 2020 
OptumRx COVID-19 Policy Update: Hydroxychloroquine and Chloroquine Use 

As we continue to monitor the impact across the country from the COVID-19 situation, OptumRx is taking action to support our clients, limit the burden on a stressed provider network and ensure our members have continued access to their medications. As new and rapidly evolving information is known, OptumRx is assessing our policy to ensure we continue to meet the clinical needs of our members and comply with applicable CDC guidance, as well as Federal, State and Local government requirements.

Hydroxychloroquine has recently been featured in the news as a potential treatment for moderate to severe COVID-19 illness. The use of hydroxychloroquine and chloroquine in COVID-19 is causing increased utilization and risk of drug shortage.
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OptumRx is implementing a quantity limit for hydroxychloroquine to preserve continued supply for chronic users with existing conditions while ensuring access for treatment of COVID-19 when appropriate. This policy will go into effect March 31, 2020.
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Policy Details: 

  • In order to preserve continued supply for chronic indications and ensure access to acute use for malaria, amebiaisis and COVID-19, OptumRx will be implementing the following quantity limit:
    • Hydroxychloroquine will be limited to 30 tablets within a 90 day time period with an automatic bypass for members who have utilized at least a 60 day supply within the past 120 days.
    • Chloroquine will be limited to 30 tablets within a 90 day time period.
  • Members newly starting on hydroxychloroquine for rheumatoid arthritis or systemic lupus will be able to request quantities beyond 30 tablets through a manual override process.
  • OptumRx will message pharmacists at the point of dispensing to encourage filling for appropriate COVID-19 use.
  • OptumRx will continue to review and determine whether there is an ongoing need for quantity limit to remain in place.

Wednesday, March 25, 2020
OptumRx COVID-19 Policy Update

We are closely monitoring the impact across the country from the COVID-19 situation and are taking further action to support you and your members at this time. As new and rapidly evolving information is known, we are assessing our policies and procedures to ensure we continue to meet the clinical needs of your members and comply with applicable CDC guidance, as well as Federal, State and Local government requirements.

We recently communicated our decision to allow members to refill their maintenance medications early to ensure they have an uninterrupted supply of medication during the COVID-19 threat. Similarly, I’d like to inform you of two new policies we are putting into place to support you, your members and providers during this time.

OptumRx Prior Authorization (PA) Extension:

To meet the needs of members and to limit the burden on a stressed provider network amid the COVID-19 outbreak, OptumRx is extending existing PAs that are set to expire on or before May 1, 2020. This policy will go into effect immediately.

  1. This intervention will ensure that convenient access to critical medications is maintained during this period when vulnerable populations are being directed to take precautionary measures.
  2. OptumRx will automatically extend existing PA approvals for most chronic medications set to expire prior to May 1, 2020 for an additional 90 days.
  3. OptumRx will re-evaluate the need for further extensions thereafter.
  4. Drugs with significant abuse potential (i.e., opioids) or those that are generally dosed for finite durations or intermittently (i.e., hepatitis agents, fertility agents)  as identified by OptumRx will follow the normal process for renewals.
  5. Prior authorization requirements for medications that are newly prescribed will remain in place.

OptumRx Specialty Medications Extended Supply Distribution:

During the COVID-19 outbreak, when a patient calls to refill their specialty medication, Optum Specialty Pharmacy will offer patients a one-time, 90-day supply of key chronic specialty medications. This policy will go into effect by March 25, 2020.

1. OptumRx will allow the OptumRx specialty pharmacy the ability to offer patients a one-time 90-day supply of key chronic specialty medications (versus the traditional 30 day supply).

2. Drugs within the following categories will remain limited to 30 days supply only:

    • Acute medications
    • Controlled substances
    • Drugs subject to REMS programming requiring 30 day dispensing and monitoring
    • Drugs with limited expiration dating
    • Drugs where storage/handling issues would increase risk of waste
    • Office-administered injectable/infusible therapies
    • Drugs experiencing supply shortages
    • Drugs dosed less frequently than once monthly
    • Drugs whose monthly ingredient cost exceeds $10,000

3. This policy will not auto-dispense medications in supplies >30 days without direct consent of the patient.

4. This policy will also not apply to patients who are newly initiated on a specialty therapy.

Friday, March 20, 2020
UPDATED COVID-19 Details for Clients

Dear Valued Client:

As your partners in health, RxBenefits and OptumRx are partnering to implement active measures to help you control the spread of the coronavirus (COVID-19).

To ensure they meet the clinical needs of members and to comply with applicable CDC, Federal, State and Local government requirements, OptumRx Clinical Affairs has implemented an early refill policy for maintenance medications. This authorization allows eligible OptumRx members to obtain early refills of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy.

  • Refill-Too-Soon edits have been lifted across all regions for all clients.
  • OptumRx members may obtain an early refill of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy.
  • The refill obtained will stay consistent with the standard days’ supply previously filled and allowed by their plan (e.g., 30- or 90-day supply).
  • This Refill-Too-Soon waiver will be continuously evaluated to determine the appropriate duration based on CDC guidance, Federal and State declarations, and other relevant data.
  • This policy is in effect for all regions and states covered by OptumRx.

Pharmacies should have received directions from OptumRx on how to process these early refill prescriptions. This is a rapidly evolving situation which we continue to monitor closely. As new information unfolds, we will be sure to update our COVID-19 website and keep you informed on any new details that impact your pharmacy benefits plan.

Please reach out to your account management team with any questions you may have.

As always, we appreciate the opportunity to serve you.

Sincerely,
Your RxBenefits Team

Thursday, March 12, 2020
OptumRx Proactively Waives Refill-Too-Soon Edits in Response to Novel Coronavirus (COVID-19)

OptumRx’s first priority is to ensure members have access to the diagnostic and treatment care they need. Optum is continuing to work with customers and policymakers on this public health challenge. To ensure we meet the clinical needs of our members and to comply with applicable CDC, Federal, State, and Local government requirements, OptumRx Clinical Affairs has implemented an early refill policy for maintenance medications. This authorization allows eligible OptumRx members to obtain early refills of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy.

  • Refill-Too-Soon edits have been lifted across all regions for all clients.
  • OptumRx members may obtain an early refill of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy.
  • The refill obtained will stay consistent with the standard days’ supply previously filled and allowed by their plan (e.g., 30- or 90-day supply).
  • This Refill Too Soon waiver will be continuously evaluated to determine the appropriate duration based on CDC guidance, Federal and State declarations, and other relevant data.
  • This policy is in effect for all regions and states covered by OptumRx.

OptumRx does not anticipate delays in dispensing prescriptions from Optum-owned pharmacies (Optum Home Delivery, Optum Specialty, Optum Infusion Services, Avella, Genoa, and Diplomat) related to COVID-19. They are monitoring the supply chain and actively working to maintain a reliable inventory.

Please reach out to your account management team with any questions you may have.

Client Services | 866.769.5987 
clientservices@rxbenefits.com

Member Services | 800.334.8134
rxhelp@rxbenefits.com

Wednesday, March 11, 2020
OptumRx Monitoring COVID-19 Health Concerns

In support of Optum’s mission to help people live healthier lives and help the healthcare system work better for everyone, we are committed to providing vital services to our members and community during times of calm as well as crisis. OptumRx is monitoring the impact across the country from the COVID-19 situation and offering the below FAQs to assist your members located in affected areas.

Does OptumRx anticipate any type of delays to dispense prescription medications?
We do not anticipate delays in dispensing prescriptions from Optum-owned pharmacies (Optum Home Delivery, Optum Specialty, Optum Infusion Services, Avella, Genoa, Diplomat) related to COVID-19. OptumRx is prepared to use anticipatory analysis to determine if, and when, we need to expand operations to include advance dispensing, workforce management, medication access, and more involved in ensuring we secure the medications needed for our patients and ability to deliver those medications to members.

How will OptumRx ensure adequate drug supplies and contingency staffing associated with your home delivery and other supply chains?
We’ve successfully managed challenging situations in the past including H1N1, Epi Pen shortage, and numerous natural disasters. We are monitoring the supply chain and actively working to maintain a reliable inventory. We’re also evaluating drug supplies going out to our pharmacies and ensuring our best practices and disaster recovery plans are implemented to meet the operational requirements of the organization.

Is OptumRx proactively waiving any refill-too-soon edits?
Our first priority is to ensure our members have access to the diagnostic and treatment care they need, and we are continuing to work with our customers and policymakers on this public health challenge. OptumRx is following all guidance issued by the CDC, state and local public health departments in supporting our customers’ needs. OptumRx is actively engaged in monitoring state and federal notices regarding any state of emergency or other dictated actions in response to COVID-19.

What if a member is willing to pay out of pocket to stockpile medications?
Consistent with AMCP and other published policy, stockpiling is not encouraged because shortages are likely to increase when stockpiling occurs. We continue to assess if policy should change as CDC guidance evolves.

If lab test confirmation is required as part of utilization management criteria of a specialty drug, how will OptumRx ensure access to the specialty drug in the case of a quarantine?
OptumRx will evaluate the need to relax required utilization management criteria including any required lab tests for those members impacted by a quarantine.

What role will OptumRx Home Delivery play in the distribution of acute prescriptions in the case of quarantine?
OptumRx Home Delivery will continue to play its primary role in the supply of chronic maintenance medications and a limited number of acute medications. OptumRx will continue to work collaboratively with our network of 68,000 pharmacies who are best situated to dispense acute medications.

Are your medications safe, or could they be carrying COVID-19?
At this time, OptumRx has no reason to suspect any concerns with medications being used in our pharmacies and is continuing to monitor the drug supply chain. OptumRx is firmly committed to the highest standards in selecting the vendors from which we source medications. Our prescription medications are purchased from approved sources that are safe and effective, and that have implemented protections that comply with all FDA regulations as well as national standards of the Verified Accredited Wholesaler Drug program (VAWD).

Will OptumRx allow members to change their retail prescriptions to Home Delivery?
If a member is interested in switching a prescription to Home Delivery, they can check through the OptumRx.com website to see if it is available. If a consumer is already on the phone, we will work with them through our normal onboarding process for new Home Delivery customers.

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