Network ​access

Key to making better decisions is having timely, accurate, and complete data. We’ve intentionally built our pharmacy network solutions to link pharmacy to payer like none other. As a result, we’re taking action earlier, delivering greater control over more prescriptions, and eliminating surprises at every stage of the claim, from first fill to settlement.

Extensive ​nationwide ​network

Tmesys™, our directly-contracted network that includes virtually all of the nation's retail pharmacies, ensures access to quality pharmacy care from proximate, trusted, and familiar pharmacies. By using our proprietary, electronic adjudication system, we facilitate real-time adjudication and claim management, providing automatic application of network discounts, injury-specific ​medication ​plans and formularies, and insightful and timely drug utilization reviews - ensuring that the right prescription is dispensed at the right time. 

Right fill from the first fill

When a person is injured, they often require treatment immediately. With our First Fill® program, an injured person can receive up to a 30-day supply of medication at no risk to you - we assume financial responsibility even if the claim is later found to be non-compensable. All they have to do is show the pharmacist their first fill card and we’ll take care of the rest. This is not only convenient, but provides you with greater certainty that the claim is starting down the right path, in accordance with plan specifications. 

Mitigate the third-party influence

Using proprietary connectivity with our affiliate, ​SRPS, Optum is the only PBM capable of electronically applying client-specific business rules, eligibility, formularies, and utilization criteria in real-time at the pharmacy point-of-sale. Our unmatched ability to consistently enforce network protocols results in significant administrative savings for our clients. We eliminate administrative hassles, such as fielding collection calls and manually scanning, or otherwise processing, paper bills. Network enforcement also increases transactional savings, as we apply discounts earlier to more prescriptions. Moreover, you avoid paying for those that are the most expensive – the prescriptions that should not be paid in the first place. The data captured also fuels robust analytics to better guide clinical decision-making.

Greater control over physician-dispensed medications

When an injured person obtains a prescription from a non-traditional source, such as a physician’s office, clinic, or independent mail order pharmacy, it can be costly and essential therapy insights can be lost. PharmaComplete®, our specialty network of occupational clinics and physician-dispensing locations nationwide, helps clients gain visibility into, and control over, these prescriptions. The result is a more holistic view of pharmacy utilization while also yielding cost-savings and ensuring the injured person receives the right medication at the right time.

Convenience and savings with mail order

For an injured person, getting to the pharmacy can sometimes be difficult. Our mail order program delivers up to a 90-day supply of medications right to their door. With a dedicated mail order customer service team and online accessibility, mail order services from ​Optum make certain injured persons always have their medicine. An online profile, refill reminders, and prescription re-orders are possible 24/7/365.

Meanwhile, our clients, experience higher savings achieved through the mail order program. Furthermore, not only do we manage conversions on your behalf, but the longer days’ supply also cuts down on paperwork; and we apply the same utilization and cost management protocols as if the prescriptions were filled in a retail environment. The result is a consistent, timely, and cost-effective program.