Experiences with UnitedHC Compass HMO, OptumRx, and/or NYS Marketplace?

25yo with chronic illnesses

Queens, NY 11377

Title says it: Does anyone have experience specifically with UnitedHealthcare and their pharmacy benefit program OptumRx through the NYS Marketplace? I’m considering their Compass HMO network.

I really need to know if I will be able to easily fill my medications that are in formulary but require a PA.

I am only 25 and have a slew of serious/chronic medical conditions that require me to see a variety of specialists and use brand name and specialty biologics medications. Unfortunately I do not qualify for disability benefits because I’m perfectly able to work (as long as I have access to all my doctors, treatments, and medications!! The irony is painful.) I have considered looking into the Medicaid buy-in program for working people with disabilities but the issue with medicaid is that most of my doctors do not take it! The only positive is that medicaid would allow easy and cheap access to all my medications and treatments…

I currently have decent BCBS insurance through my mom’s employer, but she’s moving jobs and I need to get my own insurance anyways because I’ll be 26 soon.

Looking through the options on the NYS of Health Marketplace I tried cross-referencing their network of providers with my list of specialists and the 2 plans that have most of my doctors in network are Emblem and UnitedHealthcare.

Looking at both plan formularies, Emblem’s sucks. Most of my medications aren’t even listed/searchable.

Now UnitedHealthcare seems promising because using OptumRx’s search tool, all of my medications are in formulary HOWEVER they are mostly tier 3 and require a PA.

In my experience using my parents’ employer insurance through Aetna or BCBS, whenever a PA was required for a medication or service my doctors were usually able to get it covered within a few weeks and then it was smooth sailing for a year until the PA needed to be renewed.

But what is the PA process like with UHC and OptumRx? I was told that marketplace plans are required by law to cover treatments for preexisting conditions. Does that mean it will be easier to get my medications covered/approved if I’ve been taking them for months or years?

Any advice, recommendations, experiences, or thoughts are appreciated! I’m terrified I’m going to be left without adequate healthcare for the first time in my life, and I am fairly poor but not poor enough to qualify for medicaid.