TrustRadius Research Team Analysis

OptumRx is a branch of Optum, which is the healthcare technology and analytics sector of UnitedHealth. OptumRx handles all things prescription drug related and offers services to networked retail chains and independent pharmacies. In addition, it also provides its own pharmacy services, Optum Specialty Pharmacy, and prescription drug deliveries via the postal system with OptumRx home delivery.

OptumRx is also one of the top three largest pharmacy benefits management (PBM) providers, filling over 1 billion prescriptions every year.

What Does OptumRx Do?

OptumRx offers a synchronized pharmacy experience where providers can submit and authorize prescriptions, and their patients can fill, refill, pay for, and manage their prescriptions through OptumRx’s Prescriptions Dashboard.

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Image provided by OptumRx

OptumRx for Healthcare Professionals

OptumRx for Healthcare Professionals is the business side of the OptumRx platform. This side of OptumRx defines how healthcare professionals and pharmacies can utilize OptumRx for their business. It includes sections focussed on prior authorizations, general resources, clinical publications, and services and solutions.

Prior Authorizations

OptumRx allows providers to electronically submit prior authorizations (PAs). Digital authorizations can save on time (as much as 2.5hours on PAs every week), produce faster results, is eco-friendly as it uses less paper, and ensures secure information transfer using National Council for Prescription Drug Programs (NCPDP) SCRIPT standard.

OptumRx offers two methods of electronic prior authorizations through Covermymeds and Surescripts. Both of these options require you to sign up and submit an ePA request through OptumRx.

Image provided by OptumRx

Resources

The resources section provides healthcare professionals with electronic payment solutions, FAQs and guides, and forms. Here, healthcare professionals can find any and all resources related to OptumRx.

However, one neat thing to call out about this section is the fraud, waste, abuse and general compliance subsections. Providers can find an Abuse, Neglect & Exploitation course and a Cultural Competency course. There are also several other topics covering providers rights, OptumRx Code of Conduct, and resources for reporting a fraud, waste, and abuse incident.
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Image provided by OptumRx

Clinical Publications

The clinical publications section contains three subsections: RxHighlights, RxNews, and RxOutlook.

RxHighlights: RxHighlights gives a monthly overview of treatment guidelines and key issues in the current pharmacy and healthcare environment. It includes:

New brand & generic drug approvals
New and revised drug indications or label updates
Drug safety news
Any product recalls, withdrawals, discontinuations, and/or shortages
New or revised treatment guidelines

RxNews: RxNews covers information on drug therapy issues and how they impact the current healthcare and pharmacy environment.

RxOutlook: RxOutlook covers pipeline drug information, trends, upcoming drug launches, and new therapies in the pharmacy markets.

Services and Solutions

The services and solutions section breaks down the solutions offered by OptumRx to providers. These services are:

Home Delivery
Medication Therapy Management
Pharmacy Benefit Management
Pharmacy eServices
Prescriber eServices
Specialty Pharmacy

Home Delivery: Optum Home Delivery is one of the staple benefits of using OptumRx. This solution allows providers to send prescription medication through the mail to patients. In some cases patients also have the ability to order up to 90 day supplies while only paying copays for 30-60 day supplies. What’s more, patients can select an auto refill feature which will fill the prescription and mail it out without any hassle of making a call to the pharmacy. This creates a number of benefits for the patient which leads to better care being provided.

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Image provided by OptumRx

Medication Therapy Management: Medication Therapy Management is focused on improving the therapy outcomes for Medicare Part D. Participants in this solution can reach high engagement through multi-channel outreach, which results in reduced costs. Providers can also access OptumRx MedMonitor through the clinical portal and perform consultations, record patient notes, and track overall healthcare progress.

Pharmacy Benefit Management: The Pharmacy Benefit Management solution redirects you to further resources for managing your pharmacy and healthcare expenditures.

Pharmacy eServices: The Pharmacy eServices consists of an online pharmacy portal which can assist providers with a variety of daily tasks.

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Image provided by OptumRx

Prescriber eServices: The Prescriber eServices is a real-time benefit checking tool that works from within the Electronic Medical Record (EMR) to maximize process efficiency.

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Image provided by OptumRx

Specialty Pharmacy: The Specialty Pharmacy is another core solution to the OptumRx platform. This program maximizes patient data, assessments, and provider partnerships to create better engagement and adherence. Patients are able to refill prescriptions through the Specialty Pharmacy and track their past, current, and future prescription information. For more information on this program, check out the "Welcome to Optum Specialty Pharmacy" video located below.

OptumRx Use Cases

OptumRx for Healthcare Professionals is designed to aid pharmacies and healthcare providers. If you are a pharmacy, OptumRx can help with optimizing your workload by providing forms and patient eligibility requirements in one, centralized dashboard. If you are a provider, OptumRx can make it easier for you to conduct telehealth visits as you can upload prescriptions to be filled and fill out prior authorizations for your patients.

In both cases, OptumRx also increases accessibility to prescriptions with its Home Delivery option.

Cost of OptumRx

It’s difficult to tell how much OptumRx actually costs because the cost can depend on a number of different factors. UnitedHealth makes money through premiums, fees, sales, and investments. It appears that because Optum is an operating branch of UnitedHealth, it covers its operational costs through similar financial sources.

It’s unclear if providers are charged a fee of any sort for partnering with OptumRx. However, providers can reach out to OptumRx through their contact information to further clarify this.

It should be noted that providers also have the ability to look up how much a prescription will cost their patient through their portal. This means pharmacies and providers can give accurate estimates on how much prescriptions will run their patients, and be able to offer more cost effective alternatives if needed.

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Image provided by OptumRx

How is OptumRx Support?

Users feedback indicates that OptumRx support is mixed. In some cases the OptumRx team was very on point and handled everything smoothly. However, in other cases users mentioned having issues with the support. Issues called out by users pertain to: issues with deliveries (including late/missing deliveries), issues with communications between OptumRx and providers, and issues with medication alerts (ex: a medication will be out of stock and OptumRx will send multiple notifications stating so).

Who are OptumRx’s Competitors?

OptumRx has several competitors which include GoodRx, BestRx, and CareTend.

GoodRx

GoodRx is another prescription medication solution that aims to reduce the cost of prescription drugs. Its provider mode supports healthcare professionals to compare medication prices between pharmacies and drug classes. Providers also get a personalized dashboard and are able to send coupons directly to patients. GoodRx has a smoother user interface which is easier to use and collect information from, as opposed to OptumRx that includes clusters of pages. GoodRx does not include a pharmacy services platform. Instead it provides a list of different pharmacy locations (sorted by distance) that carry a specified drug.

BestRx

BestRx offers two enterprise healthcare solutions: BestRx and BestPOS. BestRx is a pharmacy management software that allows for customizable workflows, interactive patient profiles, automated refills, and multi-dose packaging. OptumRx does not offer customizable workflows, but does offer the rest of these features.

BestPOS is a pharmacy point of sale solution that focuses on customer satisfaction workflow efficiencies. The big draw to this product is the detailed sales analysis, which allows you to keep track and compare prescription and OTC sales. OptumRx does not have a designated feature that allows you to keep track of specific prescription sales.

CareTend

CareTend is a specialty pharmacy software solution offered by WellSky. It specializes in managing compliance and workflows specific to pharmacies. CareTend’s information is better laid out than OptumRx’s, and it offers revenue management which is something that OptumRx does not have. However, CareTend appears to only play a part in pharmacy dispensing. It integrates with other tools to optimize pharmacy workflows, but it does not appear to offer a pharmacy service similar to OptumRx’s.

Additional Information

If you are interested in learning more about OptumRx you can review their education page which provides users with information about navigating and using the OptumRx platform.

OptumRx

What is OptumRx?

Categories & Use Cases