OptumRX Strikes Again

As I’ve mentioned, I have been spending the last month up here in Pennsylvania. I initially thought that I could wait until I got back to Florida to order my insulin, but that didn’t work out. So on Thursday evening I called to re order my insulin….but there were not any refills left.

Well here is the first issue. After my last visit to the endo they faxed prescriptions for test strips and insulin, so how is there 2 strip refills left but no insulin? That didnt make any sense to me but no worries let’s move on.

It was late on Thursday so my doc office was closed so I had to wait until Friday morning to get the renewed RX sent in.

I was running low on insulin so I figured that I would request the RX to be sent to a local retail pharmacy so that I can pick it up on Friday or maybe Saturday since Optum wouldn’t deliver it until Monday.

When I went to the retail pharmacy they told me they didn’t have enough to fill the order so there wouldn’t be enough until Monday.

Ok still no worries because I have enough until then.

So yesterday I went to the retail pharmacy to pick up my one into insulin order finally and she said, “ok that will be $110”

Huh, excuse me? $110 that’s supposed to be $10 or $30 at most. Apparently there is a $100 deductible on retail pharmacy prescription but not mail order. Well, there’s no way I was paying $110 for one month because I don’t ever use retail so that $100 will just be a waste.

Ok now it’s getting time to worry.

I called in to Optum RX to get the mail order filled instead of the retail and only need to pay the $25 for 90 days like usual.

I know that Optum RX has a 24 hour order processing policy but really, how long does it take to process an insulin order.

Well as I’m sure you guessed the order didn’t process and ship yesterday so now it will ship today and won’t be delivered until tomorrow.

So now I have a 90 day supply coming to me tomorrow but I don’t have enough insulin to get me by till tomorrow so I asked if there was a way to get one vial of insulin to get me through till tomorrow.

Their answer… Yes you can pick up the vial from the retail pharmacy and we will grant an override but you will need to pay the $100 deductible. Well thank you very much but that doesn’t help me at all because that’s what started this whole damn thing.

This is just ridiculous. I know it’s the policy and I know it’s the rules but I do not use retail and will not the rest of the year but I need to pay the $100 deductible for 24 hours of insulin.

I am fortunate enough to be able to pay the $100 deductible because I have no choice but what if I didn’t. What if I couldn’t afford the deductible, how would I get my insulin? That one emergency vial of insulin is a hell of a lot cheaper than the trip to the ER that it will cause.

I am being charged $25 for 16 vials of insulin but I need to pay $110 for one emergency vial?

I have been with UHC and Optum for well over a year and they can see that I haven’t filled any retail RX so it’s not like I am trying to get over on them some how.

At the end of the day I am grateful to have the insurance and only needing to pay the little amount that I do. I went 2 years with no health insurance so I know the feeling of spending $100 for just one vial, but this is why I pay several hundred a month for insurance.

Something needs to change for emergency situations.

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11 thoughts on “OptumRX Strikes Again

  1. Hi Are you able to call you doctor and ask for a bottle? I was in a similar situation and my doc gave me 2 bottles to cover until my next stash came in…They usually have some on hand.

  2. Normally yes. She would give me plenty however I am in PA right now and I live in Florida which is where my doctor is. So unfortunately that won’t help this time around which makes it more frustrating

  3. What the heck is an override good for if you still have to pay the $100. Makes no sense to me.

    It’s a shame you didn’t have any other PWDs in your area that you could turn to. I’d gladly give my neighbor a new vial of Novolog today if I knew I’d be getting a replacement tomorrow.

  4. Words can not describe how stupid and frustrating I find this – and I can’t even imagine how much more so it feels for you!!

    #dblogcheck

  5. And insurance companies wonder why they have such a bad rep? (or maybe they don’t wonder…) It’s hard to see how any of this will change without a total disruption and overhaul of the current system. Sorry you had to deal with this!

  6. Yikes! $100 is a lot! I would have been trying to find a endocrinologist in that town to call and see if they had any insulin I could have and put them in contact with my endocrinologist. I couldn’t get my insulin prescription filled for my vials when I was starting the pump because I had just (a week or so before) filled my insulin pens prescription so my doctor gave my pump trainer a vial to give me. Even though my pharmacy got the insurance company to fill it so I ended up not needing the vial, the trainer let me keep it so I’d always have an extra one. From that experience I learned — doctor offices always have supplies if needed.

  7. Kristin – I used to live in PA and had an endo here, so I probably could have called on her for a vial, but I just decided to get a full month worth because it was the same cost as just one vial.

  8. That is just utter garbage. Honestly, insulin prescriptions for T1Ds should never run out, because THERE IS NO CURE and it’s not like we’re going to be able to quit insulin. It’s like needing a prescription for air to breathe.

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