Last Updated: Feb 27, 2020
Effective March 1, 2020, UnitedHealthcare’s pharmacy benefit manager OptumRx will no longer fill home delivery prescriptions for controlled substances received by hard copy, fax, or phone – except in cases where an exception applies. E-prescribing will be required for opioids and other controlled substances.
The OptumRx policy applies only to home delivery pharmacy service and not to other types of prescription service such as in-store pickup.
For controlled substances prescriptions sent to OptumRX home delivery on or after March 1, UnitedHealthcare says that OptumRx will work with clinicians and patients to help get the prescription filled at a local pharmacy, if appropriate.
Exceptions to UnitedHealthcare’s E-Prescribing Requirement
In an update to providers, UnitedHealthcare says that this requirement does not apply to the following:
- Members living in Alaska, Guam, Puerto Rico, or the U.S. Virgin Islands
- Practitioners who have demonstrated other exceptional circumstances
- Prescribers who are exempt from state electronic prescribing of controlled substances (EPCS) requirements or the CMS SUPPORT Act EPCS exceptions
Pennsylvania law mandates that all Schedule II through V controlled substances, except when dispensed or administered directly to a patient by a practitioner or authorized agent, other than a pharmacist, to an ultimate user, shall be prescribed electronically. However, Pennsylvania’s EPCS law does include numerous exceptions – including for practices that do not have an EHR system and for practices that do not have internet access.
Since UnitedHealthcare’s policy includes an exception for prescribers who are exempt from state electronic prescribing of controlled substances, any clinician who is eligible for an exception under Pennsylvania’s EPCS law should also be eligible for an exception from UnitedHealthcare’s EPCS requirements for home delivery pharmacy service.
The Pennsylvania Medical Society (PAMED) offers more information on Pa.’s controlled substances e-prescribing law, including exceptions, here.
How to Contact OptumRx about an Exception
If you qualify for an exception under Pennsylvania law, please email EPCSquestions@optum.com to have your exemption logged at OptumRx home delivery pharmacy. UnitedHealthcare says that exceptions may also be granted if you are unable to submit e-prescriptions due to a hardship or your patient is unable to go to their local pharmacy to pick up a prescription.
When emailing OptumRx, please include a brief description of the obstacle for e-prescribing; your name, address, and phone number; and your NPI number.
OptumRx offers more resources on its exceptions policy here.
Important Note for PAMED Members: If you are eligible for an exception under state EPCS law and experience any difficulty with controlled substances prescriptions through Optum Rx home delivery, please contact PAMED’s Practice Support Team at 855-726-3348 or KnowledgeCenter@pamedsoc.org.
UnitedHealthcare’s update on the EPCS requirement for home delivery is available here.
OptumRx offers more information on e-prescribing of controlled substances on its website here. Questions on the OptumRx policy can be submitted to EPCSquestions@optum.com.