If you are new to the Optima Health plan, we recommend that you call your doctor’s or specialist’s office and tell them your coverage is changing to Optima Health. Your doctor can work with the Optima Health Clinical Care Services team to provide clinical notes and update any authorizations necessary.
If you have specific questions about your condition or on-going course of care, you can call or email Optima Health directly to discuss your situation.
Some drugs require prior authorization by Optima Health in order to be covered. Your prescribing provider is responsible for initiating prior authorization.
For those members new to the plan, Optima Health will temporarily waive prior authorization requirements for members taking drugs that would usually require prior authorization. Your prescription must be filled within 60 days after your plan becomes effective (if filling at a retail location) or 120 days after the effective date (if filling through mail order). There are some exceptions to this and Optima Health representatives can help you with your transition.
After this period, if you begin taking a new medication for which prior authorization applies then you will need to work with your doctor and pharmacist for approvals.