OptumRX Demands Survey From Network Pharmacies, Creating Big Questions

Last week OptumRX released a mandatory survey to a portion of their Network Pharmacy Providers “as part of their ongoing credentialing requirements.” The survey requires Network Pharmacy Providers to provide all sources of the medication and products they dispense, including both prescription drug and diabetic testing supplies (VAWD and VDIP).

The survey is fairly straightforward:

Darned if you do, darned if you don’t:

1. If a Pharmacy includes a wholesaler not on the list (and, consequently, one that does not have an Extension under OptumRX), will they be set up for audits, having claims denied, or worse, be dropped from the Network?

2. If a Pharmacy does not include a wholesaler and they are audited, will they have claims denied, or worse, be dropped from their Network?

3. Does this have anything to do with the Extension expiring on June 30? In essence, will it create a hit-list of pharmacies that will see more audits, denials of claims or simply, be dropped from their Network if there are wholesalers on the list that are denied an extension under Optum?

4. Is this data being shared with a pharmacy’s primary vendors (e.g. Cardinal, Smith Drug), pharmacy competitors (e.g. OptumRX mail-order pharmacy, CVS or Walgreens), distributor competitors (e.g. Parmed, Bellco), manufacturers, insurance companies, or anyone else?

About Pharma Solutions

Pharma Solutions is a leading pharmaceutical compliance services firm that uses experience, relationships and knowledge to develop custom solutions for their clients. The company provides numerous services including VAWD Accreditation, state Board licensing and federal registration. Five Rivers helps third-party logistic firms, distributors and manufacturers in the pharmaceutical industry focus on their supply chain while reducing costs, enhancing efficiency and improving quality. Five Rivers is committed to helping their clients thrive and to providing peace of mind.