CountyCare provides your pharmacy coverage through our vendor OptumRx. We use a Preferred Drug List (PDL). A PDL is a list of the drugs that we prefer you use. If you need a medication that does not appear on the PDL, your doctor may ask for a review. If you are new to CountyCare, you can continue any medication that you are currently using for your first 90 days with us.
Prescription Drug Services Prior Authorizations
To submit a prescription drug service prior authorization, complete and submit our General Prior Authorization Request Form
Due to the high cost of some prescription drugs, CountyCare maintains a Preferred Drug List (PDL) and requires prior authorization for certain prescription drugs. The CountyCare PDL includes a broad spectrum of generic and brand name drugs. Clinicians are encouraged to prescribe from the CountyCare PDL for their patients who are members of CountyCare.
CountyCare works with OptumRx to administer pharmacy benefits, including the pharmacy prior authorization process. CountyCare requires prior authorization for select drugs on the PDL as well as ALL drugs not on the PDL. Most specialty drugs are not on the PDL and require prior authorization as described below.
Follow these steps for efficient processing of your pharmacy prior authorization requests:
- Complete the CountyCare form: Medication Prior Authorization Request Form.
- Fax to OptumRx at 866-511-2202
- Once approved, OptumRx notifies the prescriber by fax.
- If the clinical information provided does not explain the reason for the requested prior authorization medication, OptumRx responds to the prescriber by fax, offering PDL alternatives.
- For urgent or after-hours requests, a pharmacy can provide up to a 72-hour supply of most medications by calling the OptumRx Pharmacy Help Desk at: 877-235-1981.
- All pharmacy prior authorization requests for CountyCare members should be submitted to OptumRx.
Specialty Pharmacy Services Prior Authorization
To submit a specialty pharmacy prior authorization, complete the appropriate drug-specific prior authorization form from the list below.
For all else, complete and submit our General Prior Authorization Request Form.
Fax all completed forms to OptumRx at 866-511-2202