Need advice regarding OptumRx

My employer unfortunately switched from using CVS Caremark to OptumRx a few years back. I am required to fill all meds through Optum's mail order. If I had a choice, I would never use or deal with them ever again, as it has been hell since day one. I have had nothing but issues with Optum. When we first switched to Optum, they created 3 separate accounts in their system and spread my prescriptions randomly across all 3. This took them months to fix, and they made me contact every provider that prescribes me meds to have them send new scripts for all my meds. After that fiasco, they have done countless things to prevent me from getting my medications. Everything needs a prior auth, and when my providers send one, Optum claims they never got it, and it turns into 10-20+ phone calls on my end with both Optum and my provider's office. The provider will issue a prior auth repeatedly for the same med and Optum still claims they never got it. They will also eventually admit to getting a prior auth and then tell me it's not the right prior auth or they need additional documentation they didn't request with the prior auth to just create a bigger hassle for me and my providers. This prevents me from getting my meds at a minimum or weeks if not 1+ months each time. They have also randomly dropped coverage of my medications during the year which I know they are allowed do, but still extremely frustrating. Another super fun thing they do is they randomly cancel my orders and then that order will disappear from my order history. I checked my order history and out of the 20 orders I can see they've cancelled 9 of those orders. So, 45% of the time they are cancelling my orders and not notifying me through text, email, a phone call, or a push notification through their app. If I refill 4 meds and 1 is out of stock, they will not ship the 3 meds that are in stock and have been filled but will hold all 4 orders hostage until the 1 med is restocked. They also are not listing estimated out of pocket costs for drugs which is illegal. I would guess around 75% or so of my meds show "Price not available". For the few meds that do have an estimated out of pocket cost listed, they randomly will say one of my meds is $250 and when I go to refill it, the order total will say $250. Each time I've called them they say, "it's $25, I don't see it showing as $250 on my end, I don't know why you'd be seeing that on your end". Every time I have to call them, I could speak to 10 different people and each one will tell me a completely different story with different excuses. They have continuously lied to me and to my providers/their clinic staff. The most recent example I have was something that happened yesterday. I have most of my meds on auto ship because I have ADHD and have a very hard time remembering to order meds, I realize I need to order meds when I take my last pill and then I'm stuck waiting 1.5-2 weeks if it's in stock, or 1+ months if it's out of stock. I realized Tuesday I took the last pill of one of my medications. I looked through my medication storage to find a new bottle and realized there was not a new bottle. I look at my account on their app, it shows that med was eligible to be refilled 05/24/24 (almost a month ago) and that it is indeed on auto shipment. I then noticed there was an order placed for that med on 05/17/24 7 days before it was eligible to be refilled, and that the order was cancelled with no explanation visible to me. I tried to manually place a refill order for that med and it won't let me. When I clicked on the med, at the top in all caps it showed, "not available for refill". I called them, spoke to 3 people, and was on the phone for 40 minutes. They told me it was cancelled because it was refilled before the date it was eligible to be refilled. I said okay why is your system filling meds on auto shipment 7 days early and then immediately flagging the order due to it being too soon to fill, cancelling the order, not notifying me, and then blocking me from being able to manually place a refill order myself? Of course no answer, more excuses. I've lost track of how many times I've been involuntarily taken off my meds due to their bullshit. It's not safe or acceptable for patients to go without their meds because Optum just seemingly feels like ruining our lives. Everything is a time consuming pointless battle with nonstop conflicting information and lies. I have lost all of my patience and sanity dealing with them. I have wasted so many hours of my life dealing with their stupid incompetent staff. I am sick of being lied to and I'm positive they are intentionally doing all of these things to deter people from using their coverage that they pay for. They've been ruining my life for years and I'm at a loss on what to do at this point. I don't understand how they keep getting away with this. My partner's employer also uses Optum, his coworker couldn't get her insulin for 3 months and almost died. My story isn't unique, but their practices are unethical, dangerous, and sometimes straight up illegal. Is there anything I can possibly do, to force my employer to let me fill my medications anywhere else? I can't mentally or physically handle this anymore. They’re playing games with people’s medications and their wellbeing. These issues and then some are happening on 50%+ of all of my meds/orders. I'm well aware of goodrx as I work in healthcare and I have a lot of chronic illnesses. Unfortunately, it's not an option for a good portion of my meds. The cost is too high out of pocket and I already pay a lot for insurance premiums as I pay for the highest tier plan through my employer. The only federal government agency I could find that regulates PBMs is the FTC. And they don't act on complaints until they've received a undisclosed amount of complaints from a undisclosed amount of different people. I've also previously contacted my state insurance board and they refused to help. Optum has clearly shown that they can do what they want with seemingly no consequences.

**Editing to add I don't fill any brand name drugs through Optum. I have 1 brand name prescription that is filled through my employer's personal specialty pharmacy. All of my meds filled through Optum are generic drugs. Also because of their bullshit with prior auths, it took me 8 MONTHS to get a medication.

submitted by /u/jordang95
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