Some medications require approval before they are covered by OptumRx. These drugs are noted in the OptumRx Formulary. Prior authorization is required for medications that are more likely to be overused or prescribed outside of clinical dosing guidelines. In some cases, there are specific dosages based on medical guidelines. Prior authorization is required for all specialty drugs.
If your medication requires prior authorization, OptumRx will contact your doctor to get the necessary information.
If your request for
a prior authorization is denied, you may still fill your prescription - but OptumRx will not cover its usual portion of the costs.
You may start a prior authorization request online:
- Go to www.optumrx.com, enter your username and password, and click “Sign in.”
- Select “Benefits and claims” in the top menu and select “Prior authorization” from the dropdown menu.
- Select “Start request now”and follow the prompts to request a prior authorization. You may also see the status of in-process requests.