Pharmacy

Benefits and programs

Important Reminders on Pharmacy Authorizations

Please note that any open pharmacy authorizations – obtained prior to Jan. 1, 2023 – will be honored through the length of the approval and you do not need to request a new authorization. While Point32Health is utilizing OptumRX as the pharmacy benefit manager for all lines of business, authorization requests should be made directly to Point32Health. You can submit authorizations in one of several ways, though we encourage electronic submission for ease and speed.

Formularies and Drug Lists – Access important drug coverage information.

Utilization Management – Learn more about our utilization management program and how to submit prior authorization for medications.

Pharmacy Updates – View monthly updates to the drugs covered on our formularies.

Convenience and Speed: Use PromptPA to Request Drug Authorization

Submit your requests for prior authorization — for both pharmacy benefit and medical benefit drugs — using our easy-to-use electronic tool, PromptPA. View drug-specific criteria, attach clinical information, check the status of your request, and receive a response more quickly.
 

Useful Resources for Opioid Prescribing

• Physicians for Responsible Opioid Prescribing (PROP) – PROP’s mission is to reduce opioid-related morbidity and mortality by promoting cautious and responsible prescribing practices. This site provides information about opioid risks and benefits for providers and consumers.
• Overdose Prevention kit – SAMHSA – This site provides information to prescribers, first responders, and family members about preventing overdose and the role of naloxone.
• Opioid risk evaluation tool – The Opioid Risk Tool (ORT) is a self-report screening tool that can be administered and scored in less than one minute, designed for use in primary care settings to assess risk for opioid abuse among adult patients prescribed opioids for treatment of chronic pain.
• MED Calculator – This site is connected to an online tool to calculate Morphine Equivalent dose of all opioids to support MED limits in guidelines. This calculator should NOT be used to determine doses when converting a patient from one opioid to another.
• Mass Medical Society – Offers information for physicians/prescribers as well as patients and families, including information on opioid overdose and naloxone, preventing prescription drug misuse, and safe storage and disposal information of opioids.
• CDC Website – The CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations about the appropriate prescribing of opioid pain relievers and other treatment options to improve pain management and patient safety.

Mail Service Prescription Drug Program

Our mail service program offers a quick, easy way for members to get their maintenance medications. The program, which is administered by OptumRx Home Delivery, includes:

• Delivery of an 84-to 90-day supply of medications to your patient’s home
• Easy ordering — e-prescribe or order by phone (855-258-1561) or by mail using the OptumRx New Prescription mail-in order form
• Free standard shipping on all prescription orders
• Potential copay savings

Be sure to prescribe an 84-90-day supply, plus refills when appropriate.