December 11, 2019
Area(s) of Interest: Drug Prescribing/Dispensing
OptumRx, the pharmacy benefit provider for UnitedHealthcare, will require e-prescriptions for opioids and all other controlled substances for its home delivery pharmacy service effective January 1, 2020. The policy only impacts prescriptions for controlled substances through Optum Rx home delivery pharmacy and does not affect other retail prescriptions processed by Optum Rx. The new policy, first announced in United Healthcare’s August 2019 Bulletin and updated in its October 2019 bulletin, will require the electronic prescriptions to be sent through an Electronic Prescribing of Controlled Substances (EPCS) certified software system, which would be obtained through your current practice electronic health record provider.
Following the announcement of the new OptumRx policy, the California Medical Association (CMA) made outreach to UnitedHealthcare to share our concerns with the change in policy and to discuss the potential impact on our physician members and their patients. CMA is particularly concerned with the potential for disruption in patient care if a physician lacks the technology, hardware or certifications required for EPCS. In response to CMA’s concerns, OptumRx has shared that it will offer a two-month grace period where all prescriptions will be filled regardless of if they were sent electronically. Effective March 1, prescriptions for opioids and all other controlled substances through its home delivery service must be submitted electronically.
UnitedHealthcare members may continue to obtain prescribed controlled substances through Optum Rx using non-electronic prescriptions issued outside of an EPCS certified software system at their local retail pharmacies through January 1, 2022. A new California law (AB 2789) will require all prescribers to use e-prescribing for all prescriptions unless they qualify for an exemption starting in January 2022.
Federal law will also require physicians to electronically prescribe controlled substances for Medicare patients effective January 1, 2021. The OptumRx home delivery policy implements the requirement much earlier than would be required under the changes in state or federal law.
The OptumRx home delivery pharmacy policy will be subject to limited exemptions. For more information, visit professionals.optumrx.com/epcs. There you will also find a short video that provides more details regarding the transition to e-prescriptions.
For more information on of the upcoming state and federal e-prescribing requirements and possible exception, see CMA health law library document #3201, “Controlled Substances: Prescribing.”
Physicians who have questions about the new OptumRx policy should contact UnitedHealthcare at (877) 842-3210 or visit UHCprovider.com.