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OptumRx

OptumRx review: Optum prior authorizations

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2:42 pm EDT
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My daughter needs an antibiotic, she has alpha gal so she can only take specific meds, liquid clindamycin. Everytime we fill this med they want another PA that takes forever, you get different answers depending on who you talk to, they transfer you to Tenncare, Tenncare tells you that you need to talk to Optum. I've waited for over two weeks trying to get this antibiotic. I was finally able to get them to approve what the pharmacy had in stock (2 of 6 bottles) and was told to return in a few days to pick up the rest of the antibiotic. When I returned the pharmacy said they are still waiting on a PA. Called Optum, they told me to call Tenncare, who told me to contact Optum, who then told me to contact Dentaquest. What is going on with this company? I spoke to 3 people within 30 min and got 3 different answers. I just need this antibiotic and there is no reason they need a PA other than the cost of the liquid medication that she HAS to have. Why are they questioning this prescription everytime it is sent in? She still doesn't have the antibiotic in hand as it's over $300 out of pocket. I have given up on getting tenncare or optum or dentaquest to get anything correct so I have resorted to sending in this complaint and will continue to complain until I get this antibiotic. No medication should require this much effort. I do expect to hear from someone regarding this complaint so I will be checking my email. Hopefully nothing detrimental healthwise comes of this since she has gone over two weeks without the antibiotic she needs for an infection and us not being able to get a PA approved, after 2 bottles were approved a few days ago.

Claimed loss: the loss would be my daughters health as she needs this antibiotic for an infection, going on two weeks waiting for a PA

Desired outcome: Cover this prescription quickly and stop requiring a PA for her liquid antibiotics because that is all she can safely take due to alpha gal.

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