We have just been notified that our drug coverage is changing to this company - Optum Rx. Quite scary as they are suggesting that I get my oncologist to find an alternative drug to Ibrance which has worked for me since March 2017. I am not on Part D Medicare despite being nearly 78. I kept my private insurance when I retired from the State of Florida in 2010 for this very reason. Anyone familiar with this company????? Hugs and blessings to all. Hannah
Optum Rx: We have just been notified... - SHARE Metastatic ...
Optum Rx
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Lilywallytootsie
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I have had no issues with them. Fast delivery (even when I wait to the last minute to reorder). Friendly people on the phone etc.
Thanks. That is good to know that your experience has been good. I have been afraid of them Shipping UPS ground to Florida. Those UPS trucks can reach 140 degrees very quickly and Ibrance needs to remain at room temperature except for very short excursions. Mine has been shipped UPS air with early morning delivery usually around 8:00 a.m Again, thank you. Blessings, Hannah
They pack it in ice packs! I saved these to use for picnics and other purposes 
Drugs just need to be shipped according to manufacturer's and FDA recommendation. But that means air conditioned vehicles. It would also help if FDA required drugs to be tested for the coldest and hottest temperatures the drugs could stand without being compromised. It would be impossible to go back, but they could go forward with every new drug. There is a large grassroots movement with many folks who are in the medical field or who had an experience that made them realize the problem with drug shipping. Folks are speaking at medical schools, boards of Pharmacy's and any other place they can speak. My husband and I spoke at the Florida Board of Pharmacy in 2019. They are a joke. They are appointed by the political party in control at the time. The foxes are guarding the hen house. Controlling votes are controlled by big Pharmacy. Large donations get you a seat. I was hoping to be able to continue but my health is just not good enough. It is a circle though. The FDA controls drugs leaving the manufacturer to the first warehouse at which point it is under state control. The problem is States are all over the place and most are political appointed board members. There are a few states that do have good strong regulations and aren't controlled by the big guys. The problem is they have no control over what happened before it came into their state or when it left their state. This problem is also with over the counter drugs. A baby almost died because the formula his doctor wanted him to take had been stored in a very hot warehouse with no air conditioning. The best the medical inspector could get done was a few commercial fans installed. Hospitals rarely check to see if the medication is the problem and it's difficult to prove that the purchaser didn't in some way store it incorrectly. The solution is going to have to come from the FDA. If anyone is interested in becoming involved in the movement, I can put you in touch. Speaking about it helps. Most folks are not aware. Lester Holt of NBC News did a story on it several years ago. Among other things they showed someone frying an egg on a USPS cart. They attached a link that you could real individual horror stories. Sorry this is so long and is bringing to light something people would prefer not to know. But this should not be happening. It's the greed that has overtaken the country. Hugs and blessings all. Hannah
Thanks for that information. Discouraging as it is, it is better to know.
They package accordingly.
When I first got the Ibrance from OptumRX's specialty pharmacy they packed it on ice as I am in Florida, too. Then, they stopped doing that. Sometimes the packages were quite warm when I received them. I contacted Pfizer and they said it would have to reach high temps for a long time before it would be an issue. ExpressScripts has never sent it with ice packs. Not sure why things changed. The Ibrance is still working for me so I don't think it has been compromised by not being on ice. Lilywallytootsie's post is very informative and interesting. I definitely did not know all of the intricacies of Big Pharma.
They are a subsidiary of United Healthcare. I believe. I used to have them when I worked and I think they quite good . But it’s weird that they’re asking you to find another drug when Ibrance is such a common standard of care.
(I have Medicare Part D but have gotten Ibrance and now Piqray free directly from the drug company. They would have been very expensive even with Part D insurance. Fortunately, beginning in 2025, people with Medicare Part D will have an annual limit, capping their out-of-pocket prescription drug costs at $2,000. )
It’s really fantastic that you’ve been successful with Ibrance for so long. I’d not want to rock the boat either. I hope you can work it out with them. Maybe your doctor can help?
Best wishes to you!
Helen
I have been using OptumRx for a long time and loved them. Easy to deal with, got new scripts from my doctors, did auto-refill, reminded me. If I needed something fast, they would ship it overnight. So efficient in that way.
I just had to switch back to Rite Aid. I don't know what is going on at OptumRX, but I was speaking to an ignorant customer service person who wanted to talk to my oncologist about changing from exemestane to anastrozole. I explained to her 10 times (well, 3 times, at great length) that I was going on exemestane because anastrozole failed. And she better not call my oncologist.
That is crazy. They cannot be making decisions about treatment.
There is no alternative to Ibrance if that is what you should be on at this time. I always had to get patient assistance from the pharmaceutical (in the case of Ibrance, from Pfizer) so I got it free and did not use insurance. When I got it free, it came from a local specialty pharmacy. I don't think OptumRx carries any of the targeted medications. (I got Verzenio from a specialty pharmacy also, and they shipped it locally and were also good about delivering refills in a timely fashion.) There is something wrong with this picture.
Dana Farber calls anyone with 5 years on Ibrance an exceptional responder and they are stu f Ying these folks. You have 6 years! That's amazing. They haven't denied the Ibrance yet if/when they do call them find out the basis for denial, get a phone number - your doc should be able to appeal over the phone (faster and easier than in writing). I suspect they will grant continued use. I worked for the federal government and kept my insurance (I'm sure I would be dead now if I didn't have that insurance, no way I could afford all this). My insurance recently denied orserdu for me (I had 5years on Ibrance and about 13 months on faslodex. I talked to insurance (I was worried they would try to force me to take chemo) I gave the doc the phone number to call and orserdu was approved 24 hours after she or her nurse talked to them. Good luck! It would be ridiculous for you to stop Ibrance if you don't have progression. Let us know how it goes for you. Treatment is so expensive!
I worked for OptumRx and couldn’t even get my Ibrance from my own site. It had to be shipped from another state after it got approved. I was originally supposed to get Verzenio but they absolutely would not approve it even after appealing denials. I was on Ibrance for 3 1/2 yrs then it failed and all of a sudden Verzenio got approved. Well, that stopped working & I had to start Xeloda in May 2022. I was sent the generic but they do use different manufacturers. I had a reaction to one manufacturer and called OptumRx and told them to never send me that manufacturer again. Well, during that time, I’d call for my refills (never rely on the company getting your meds on time) & they had none in stock! I also had a pharmacist tell me to go find it myself at a local pharmacy-which is ridiculous! Little did they know that I worked for them and took care of cancer patients! Believe me, they got a piece of my mind numerous times. I also recommend that you request FEDEX am deliveries. Many times UPS never delivered on time. Always be your own advocate! Never wait until the last minute-give enough time for delivery in case of predicted bad weather. Always check the number of refills you have left-if none, call your doctor to have a new rx sent to OptumRx. OptumRx will fax a request to the doctor but they never follow up if they don’t get it. This happened to me & my schedule got screwed up. I no longer work for them-under my husbands insurance.
We used to have Optum RX and had no issues. Our insurance company switched to ExpressScripts this past year and they have been okay, too. We received the same letter from ExpressScripts saying that Ibrance would no longer be considered a preferred medication and suggested Kisqali or Verzenio or said we might have to pay a large co-pay to stay on Ibrance. I am not switching as Ibrance has been good to me so far. Then we received a call from a company called Save-on which had partnered with our insurance to ensure I could still receive Ibrance. It makes me angry that insurance companies don't really care about patients and it's all about the money. Not sure why they want to take patients off meds that are working and make them switch to something that might have way more side effects and not work as well.
Hi Lily!
They are awesome! I use them for my regular meds and my specialty meds (Ibrance). Shipping is FAST and there is never any issues. I have the app on my phone and I also have automatic refills scheduled.
The Ibrance is always packed nicely in ice in the summer and they notify AND actually CALL ME when it is delivered so I can grab it right away.
You won’t be sorry!!
They even have a number you can call to discuss any concerns about your meds (with a pharmacist).
I hope you love this company as much as I do!!
Blessings,
Jody
Seems like your experience is good, and different from Lilywallytootsie's. OptumRx is sending you Ibrance. Her experience is more like mine: they are trying to change her medication from the one she is and should be taking. This is not okay. OptumRx should not be overriding your oncologist's decision about the best treatment, and what is clearly the right course for you. You should change treatment only when the current one stops working and LWT is having a remarkable response to Ibrance. (I have Medicare Part D but got Ibrance free through their patient assistance program, and it was shipped from a local specialty pharmacy -- same day!)
I think it’s more to do with your insurance and not necessarily the pharmacy. It’s what the insurance company dictates. 😢
Not at all. My insurance will cover the medication I need to be on when I get it from my neighborhood Rite Aid. It is OptumRx that tried to talk me into a different medication.
That is so strange? Why would they not want to fill a prescription that your doctor ordered? That makes no sense to me because they have no clue what your labs/scans are. I was in the pharmacy field for over 40 years and I have NEVER heard of that!!
Hmmmm. I’m stumped!! 🙏🏻
The replies regarding Optum Rx are all over the place. I used to work for the State of Florida and decided to keep that insurance as secondary to Part A and B to Medicare which is required. We have had to pay both parts - ours and the state's which is quite a bit more than just buying a Medicare supplement. It has worked beautifully since I retired in 2010. We don't have to go over plans annually that are confusing and all change each year.
The state said that the change was made this past October to take effect Jan. 1st. The problem with that is that it arrived right when retirees were being bombarded with Medicare plans for 2024 and ours probably went straight to the trash as junk mail. We had no reason to look for a new plan or so we thought.
The letter to change my Ibrance would probably have ended up in the trash, but there were three letters and I opened one. After, finding that it was a done deal before I knew that it was even being considered made me realize the state of Florida sucks. I then called the Specialty Pharmacy and got someone who spoke limited English. They would not give me a price for/or option unless I placed an order. He repeatedly wanted me to repeat the same information. Finally asked for a supervisor and he said certainly, just one moment where I was connected to a robot who kept asking for the same information. My husband is writing every state official who has the slightest chance of helping us. I was able to find out that this all originated with the State Division of Insurance who has more than likely ordered a death warrant for me. The governor and the chief financial officer of Florida wives were both diagnosed with breast cancer and go to Moffitt Cancer Center where I go in the last couple of years. But neither had stage 4 so they would not need to take Ibrance. Insurance should not be this complicated and it should be easy to compare policies and patients should have at least a years notice before any big changes. And it should be sent by registered mail to be certain that everyone received it. I don't have the energy or will to fight these a$$holes. I hope my husband does. Getting medical care should not be so stressful especially when you have excellent insurance. No, it shouldn't be stressful for anyone. We all deserve the care we need.
Blessings and lots of hugs to all.
Hannah
So there is a fatwa on you? For complaining about insurance? Of course it shouldn't be so complicated. I never went for Medicare Advantage because it really is impossible to figure out what they cover, and which docs are in network, etc., and they keep changing. It is a shame that we have to fight so hard to get what we need.
You are right that the answers about OptumRx are all over the place. Some people were even able to get Ibrance from OptumRx -- but they don't want to give it to you. Some people talked to a reasonable oncology nurse. I talked to someone who knew nothing, kept confusing brand names and generics, as though they were different medications, and wanted to change my treatment plan. I had to repeat everything for an hour. You can't go to another pharmacy? That is what I could do, and had to do. Fortunately, the out of pocket cost was only $30, without insurance. Not so for Ibrance.
There are times when we cannot advocate for ourselves. I am watching that happen to people on this board who are not well enough to keep challenging insurance, inept doctors...Fortunately I still can, because I have no one to take over. Sounds like you have a husband who can fight for you.
And I wasn't able to get pricing for a name brand (that I did not want but they did have) until I got a letter from my doc asking for it and ordered it. They must be able to look it up, but couldn't tell me. Maybe it is like interest rates, can change day to day??
If your cancer center has a patient advocate person, talk with them and have them talk to Optum for you. If they dont have an advocate, try the billing person. I was only on Ibrance for a year but was able to get the manufacturer to pay for it. My cancer center took care of all the paperwork.
Best wishes.
They are excellent, my oncologist has been using them for 3 years for me. They ship quickly and no issues. They also have very knowledgeable nurses on hand to answer questions you may have. I'm working with an oncologist nurse through them on the phone. Sabrina is wonderful, she has so many resources for financial help, and grants. Don't be upset. Good Luck!
that's who I have and I retired in 2009 from the State of Texas. My co-pay for ibrance is $56.00 but I have part D, along with my medicare advantage, I don't know what it would be without the part D ...
Hi Godbeforeme!!
Who do you use as far as the insurance company with your part D? I am still on private insurance so it’s not a problem yet, but I’m worried about when I have to switch over to Medicare. 🙏🏻
Jody
United Healthcare PPO
Thank You!! That’s who my dad has and it’s excellent!!! 🩵
I get mine directly from Pfizer, by UPS, overnight. They always leave it on the front porch, I always make sure I’m home for the delivery. Now this makes me nervous about the temp in the trucks. I’m going to call Pfizer and I’ll get back with all of you, have a wonderful day!
It is a great, efficient, reliable company.
Call your onc's office and leave a message about this! Ask if the Rx can be sent to whatever pharmacy you have used in the past That worked for us when we had optum quite a few years ago.
Yes, I had a good experience with Optum filling my Ibrance prescription. They had some prescription assistance program that covered the co-pay!
I've had them for a while. I haven't had any issues with them.
I have Anthem Blue Cross Medicare PPO insurance (as my CalPers retirement health insurance through the state of California). My Ibrance is filled through OptumRx Specialty Pharmacy. I've been on 125 mg. of Ibrance for over 7.5 years without progression. I haven't had any problem getting my Ibrance. I hope you can get this straightened out. I think you should appeal in writing and get your doctor to help you document that this medicine has been helping you for a period of time already.
I have Optum Rx through a Medicare private PPO (Advantage/Supplemental hybrid), and have been on Ibrance since January of this year. It is working well in combination with letrozole. I have not been able to get 2024 Ibrance pricing from them yet, but had heard that Ibrance might specifically be on the list for the Inflation Reduction Act for next year but have no specifics. I like the idea of $2K max out of pocket if it's true! Anyway, my Optum Rx plan has a $6500 max out of pocket for all meds, but last year with deductible (bc I was diagnosed in Jan) I hit $4,000 in the first two months and then was suddenly accepted for Patient Assistance Program by Pfizer. I am reapplying for next year, with the help of my doc's office at Memorial Sloan Kettering. I suggest you also apply, esp. after 6 years or paying! Also, I have only been on pills, not capsules, and no one has ever mentioned any temperature restrictions. Is that a problem only with capsules? Another reason to probably try to get on PAP with pills. Don't forget that if you apply for PAP they still have info on your insurance, and while it seems like you're getting it for free on PAP, they still collect from your insurer because they have a contract with them. I say let Pfizer and your insurance company pay for it! And good luck with your treatment.
Right, even if you are getting it free, your insurance is still charged. I got into the donut hole even though my out of pocket expenses were not that high. Turned out that whatever payment there was for Ibrance put me there, unbeknownst to me. At that point, NONE of my other meds were covered. Fortunately, this happened toward the end of the year and I had to cover only one month before I went back to zero.
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