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.