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Our Specialty Pharmacy covers prescriptions for certain specialty medicines for complex conditions like cancer, multiple sclerosis, and rheumatoid arthritis. These drugs, which may be taken orally, by injection or infusion, are usually not available through a retail pharmacy or home delivery because they need special storage and handling.
If I send in a referral for a specialty medication and you discover a prior authorization is required, how soon will I be informed?
We’ll contact you as soon as we learn a prior authorization is needed to process your patient’s prescription. Usually you can expect a call from us in less than 24 hours after submitting a prescription to Optum® Specialty Pharmacy.
Will you manage the prior authorization process for me?
Whenever allowed, we will initiate, facilitate and manage the prior authorization process for you. That includes getting the appropriate forms that need to be submitted and completing as much of the demographic and clinical information as we have available before faxing it to you for approval. In some cases, your office is required to request the prior authorization form directly or complete it online or by telephone. In these cases, we will notify you immediately and provide as much support and information as we can to help save you time.
What do I do once I complete the prior authorization?
You can fax it to us at 1-877-292-5799 and we will submit the prior authorization form to Health New England for you. We will work through the entire process to make sure the prescription is completed and delivered to your patient.
What if I want to process the prior authorization myself?
We are happy to work with you and provide as much support as you need in order to make your job easier. Please just forward us the prescription order and indicate that you have already submitted the prior authorization.
What are the customer service hours for Optum Specialty Pharmacy?
Monday through Friday, 9 a.m.–8 p.m.
A clinician is always available 24 hours a day, 7 days a week for emergency on-call services by calling our toll-free number, 1-877-633-4807.
To learn more about Optum Specialty Pharmacy, visit specialty.optumrx.com.