Optum Rx to Manage Prior Authorization and Step Therapy Requests
On January 1, 2025, Optum Rx will start managing prior authorization and step therapy requests for prescription drugs for members of the plan offered by Golden Rule Insurance Company in certain states, in an effort to make the process more streamlined using UnitedHealthcare's clinical criteria for the prescription benefit management of those clients.
This change applies to:
- Alabama
- Arkansas
- Colorado
- Iowa
- Kansas
- Kentucky
- Maryland
- Michigan
- Mississippi
- Nebraska
- Nevada
- Ohio
- Oklahoma
- South Carolina
- Tennessee
- Virginia
- Wisconsin
- West Virigina
- Wyoming
Streamlined Prior Authorization Requests
Optum Rx also provided providers with another two avenues for requesting prior authorizations: Online submissions at the Prior Authorization for Prescribers webpage, and call requests made through Optum Rx's prior authorization department at 800-711-4555. Now, this may help streamline submittals across different avenues, thus perhaps making provider approvals easier.
Real-Time Benefit Checks with PreCheck MyScript
Prescribers can also take advantage of the services offered by PreCheck MyScript, a digital benefit tool, to check coverage and pharmacy benefits for the UnitedHealthcare member. Using the feature, prescribers can rapidly run pharmacy trial claims and obtain information regarding coverage that can help inform the decision-making process to ensure patient care is appropriately directed.
