WHA to Partner with OptumRx in 2020

Published: December 2, 2019

Western Health Advantage is pleased to announce that starting January 1, 2020, OptumRx will manage pharmacy care services for WHA members with pharmacy benefits. WHA’s new partnership with OptumRx will help keep our rates competitive and enable us to continue offering excellent health care to our members. OptumRx provides 24/7 access to pharmacists, online prescription management, and tools to find pharmacies.

What WHA Members Should Do Now

In December 2019, members will receive new member ID cards that include OptumRx information. Members should keep the new cards in a safe place until they can start using them on January 1, 2020. In the meantime, members should continue using their current retail or home delivery pharmacy until December 31, 2019.

What Members Should Do After January 1, 2020

When the new year starts, members must use their new ID card when getting care and filling prescriptions. Pharmacies will process the claims using OptumRx information on the back of the card.

Most pharmacies are in the OptumRx network, which includes large national chains and many local pharmacies, so the transition should be seamless. In the few instances in which a pharmacy is not in OptumRx’s network and a member has remaining refills, they can request that their pharmacy transfer their prescription to a pharmacy in the OptumRx network, or ask their doctor to send a new prescription to the new pharmacy.

Home Delivery Medications

WHA members who are currently using home delivery should make sure to have at least a one-month supply of any medications they take regularly to last during the transition. Most home delivery prescriptions with remaining refills will automatically transfer to OptumRx. However, billing information will not transfer. The reason for this is that to keep personal information safe, payment information cannot be shared between pharmacies. Prior to their first home delivery order, members will have to call OptumRx to provide them with their preferred payment method to start home delivery service.

OptumRx is sending correspondence to members who have remaining refills with additional details about how to ensure a successful transition. Members should also consider enrolling in OptumRx home delivery for medications they take regularly at optumrx.com. Home delivery lets a member order up to a 90-day supply of medications they take regularly, which may save members money on copays.

Specialty Medications

Members who take specialty medications should contact OptumRx to transfer their medications to OptumRx Specialty Services as this cannot be done automatically. OptumRx will help members transfer medications after coverage starts. OptumRx’s patient care coordinators and pharmacists are trained to understand special therapy needs. In January, members can call a specialty representative at 1-855-427-4682 and register online at specialty.optumrx.com.

All WHA members should watch their email and mail for additional information from OptumRx about prescriptions. Once coverage begins, members should set up an online account at optumrx.com to take advantage of additional features of our new pharmacy benefit manager. WHA Member Services is available to help at 888.563.2250 to help members use their pharmacy benefits and troubleshoot any issues.

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