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Support for providers

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Care you and your patients can count on

At Optum specialty and infusion pharmacies, we make patient referrals, enrollment processes and online prescriptions easy for providers.

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Adherence

Clinical counseling, educational tools and a texting program support patient adherence while keeping you informed.

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Financial assistance

We offer funding tracking, program enrollment and proactive coverage to keep therapy affordable and accessible.

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Medicare Advantage

Our industry-leading coverage helps reduce pharmacy hassle for seniors, so you can focus on what really matters.

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How Optum helps you and your patients

We make a fragmented health care system simpler to navigate. Through patient-centered services, convenient tools and a commitment to accessibility, our dedicated team supports providers and advocates for patients throughout the course of treatment.

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Accessibility

Licensed to provide pharmacy support nationwide.

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Patient advocacy

99% satisfaction rate for Optum Therapy Solutions.1

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Financial assistance

$478.6 million in third-party assistance secured in 2020.2

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Condition-specific teams

We help patients and providers achieve positive outcomes.

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Our appeals team helps patients 

Our appeals team’s efforts have helped overturn eight of out 10 coverage denials and have helped more than 2,500 patients whose coverage was previously denied to get the treatments they need.3

Learn more

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Speaker 1:

The team was created in response to the changing dynamics in healthcare. At that point in time, we started to see a lot of denials and patients having difficulty getting access to the medications and treatments that they really needed.

Marisa:

When we get a denial on a patient, the first thing that we're going to do is review medical policies for the insurance company. Every insurance company is different and things that they ask for are going to be different and specific to each patient's plan. So, once we have that knowledge base, then we focus in on what that individual patient is experiencing, what their symptoms are, what medications they may have tried in the past are, and we write a letter that is specific to them.

Kelley:

I called the patient and I said, not only did we get it approved, but we got it approved for you for a year. I remember saying, "That just made my day." And the patient said, "You just made my life." I get goosebumps just every time I think about it, because it's such an incredible feeling to know that you have that kind of impact. It's challenging and rewarding all at the same time.

Ana:

We are an advocate for these patients. We treat them. I always think of them as my mother, my brother, sister, father, how would I like to be treated if I was in this situation? And I treat my patients the same way.

 

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How we help

We make patient referrals, enrollment processes and online prescriptions easy for providers — so you can focus on caring for patients, their way.

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  • Find everything you need in one place:

    • View prior authorization status, initiate appeals and see denial history
    • Track prescription status and referral activities with enhanced dashboard views
    • Easily search for patient medication lists, allergy information, diagnosis codes and insurance information
    • Access more features coming soon to streamline your process

    Request access

    Sign in

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  • Our appeals team’s efforts have helped overturn eight of out 10 coverage denials and have helped more than 2,500 patients whose coverage was previously denied get the treatments they need.4

    Learn more

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  • Our continuing education (CE) presentations cover the latest in treatment and specialty medication and infusion therapies options while providing 1 hour of CE credit for participation. Your Optum account manager will host the interactive experience at a location near you or virtually.

    Each presentation includes:

    • A live video conference call with an Optum Specialty Pharmacy pharmacist
    • Specialty medication information including dosage, side effects, drug interactions and other important data

    Check the schedule to find upcoming presentations or contact your Optum Specialty Pharmacy account manager to learn more.

    See the specialty schedule 

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  • As an approved 340B partner, we help your resources reach more eligible patients and provide more comprehensive services.

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  • Spend less time on paperwork and more time providing great care with secure EMR sharing and automated prior authorizations.

    EMR Share 

    EMR Task 

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  • We accept all major insurance plans. This includes Medicare Part B, Part D, Medicaid and commercial insurance. Copay assistance may be available to patients.

    In 2020, funding for the following specialties totaled $478.6 million5:

    • Autoimmune: $247,830,145
    • Cystic fibrosis: $11,722,197 
    • Hepatitis C: $7,494,515
    • HIV: $18,154,510
    • Muscular sclerosis: $66,956,397
    • Oncology: $64,683,189
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  • We offer providers of infusion patients a variety of resources, including: 

    • Dedicated account managers who will share important information throughout treatment
    • Patient outcomes tracking and data management 
    • Access to an appeals team that will create a customized, patient-specific letter with cited medical research
    • Benefit verification and insurance authorization
    • Immunoglobulin-specific forms
    • Optum Patient Exchange, a secure platform that provides insight into therapeutic responses

    View infusion resources

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  • Patients can find support from clinicians and patient care coordinators on their personalized online portal. They can also schedule a virtual visit and connect with other patients on Optum® Connections, a platform featuring advice from clinical experts and testimonials from real patients.

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  1. 2018 Optum survey 
  2. Optum Specialty Pharmacy Tableau Optum Rx Alternative Payer Dashboard 
  3. 2020 Optum Specialty Pharmacy internal analysis
  4. Ibid.
  5. Optum Specialty Pharmacy Tableau Optum Rx Alternative Payer Dashboard