Starting January 1, 2024, Optum Rx will become the new pharmacy benefit manager (PBM) for Mass General Brigham Health Plan. This strategic partnership is designed to offer members enhanced pharmacy services, cost-effective medication management, and a seamless healthcare experience. Below is everything you need to know about the Optum Rx Mass General Brigham Health Plan and its benefits.
What is Optum Rx?
Optum Rx is a leading pharmacy care services company that manages pharmacy benefits for health plans. Their primary goal is to make prescription medications more affordable and accessible to members. With the Optum Rx Mass General Brigham Health Plan, members can expect robust support in managing their medications and pharmacy needs.
Key Features of the Optum Rx Mass General Brigham Health Plan:

1. Online Tools and Resources:
Members of the Optum Rx Mass General Brigham Health Plan will have access to advanced online tools to:
- Search for in-network pharmacies.
- Estimate medication costs.
- Check prescription drug coverage.
These tools empower members to make informed decisions about their pharmacy care.
2. Cost Transparency:
One of the standout features of the Optum Rx Mass General Brigham Health Plan is its focus on cost transparency. Members can easily check medication prices, understand their coverage, and identify cost-saving opportunities.
3. Medication Management:
The Optum Rx Mass General Brigham Health Plan offers medication management services that include:
- A comprehensive formulary to search for covered medications.
- Support for specialty pharmacy needs.
- Tools to manage prescriptions and refill reminders.
4. Seamless Integration with Healthcare:
The partnership between Optum Rx and Mass General Brigham Health Plan ensures seamless integration between pharmacy benefits and overall healthcare management. This enhances coordination among healthcare providers, improving outcomes for members.
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Why the Change to Optum Rx?
The transition to Optum Rx reflects Mass General Brigham Health Plan’s commitment to offering members the best possible pharmacy benefits. Optum Rx’s expertise in pharmacy care management and its innovative tools ensure that members receive top-tier services.
How to Use the Optum Rx Mass General Brigham Health Plan?
Step 1: Access Online Tools
Visit the Mass General Brigham Health Plan website to explore online tools provided by Optum Rx. These tools are designed to help you locate pharmacies, check medication coverage, and manage your prescriptions.
Step 2: Understand Your Benefits
Review the pharmacy benefits guide available on the health plan’s website. It outlines coverage details, formulary information, and resources for specialty medications.
Step 3: Fill and Manage Prescriptions
With the Optum Rx Mass General Brigham Health Plan, filling prescriptions is convenient and straightforward. Members can use the online platform to refill medications, set reminders, and track their prescriptions.
Personalized Pharmacy Support:
One of the defining features of the Optum Rx Mass General Brigham Health Plan is its focus on personalized pharmacy support. Optum Rx uses advanced analytics and member data to provide tailored recommendations for managing medications.
This includes identifying cost-saving opportunities, suggesting generic alternatives, and providing medication adherence reminders. Personalized support helps members stay on track with their prescriptions while minimizing out-of-pocket expenses, ensuring a more convenient and efficient healthcare experience.
Specialty Pharmacy Expertise:
For members with complex health conditions requiring specialty medications, the Optum Rx Mass General Brigham Health Plan offers a robust specialty pharmacy program. This program provides enhanced support for managing high-cost or high-complexity medications, including those for chronic conditions like rheumatoid arthritis, cancer, or multiple sclerosis.

Optum Rx specialists collaborate with healthcare providers to ensure members receive the right medication and guidance for their treatment plan. Additionally, specialty pharmacy services include delivery options and counseling to help patients understand their therapies better.
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Focus on Preventive Care:
The Optum Rx Mass General Brigham Health Plan places a strong emphasis on preventive care through pharmacy services. Members can access programs that promote health screenings, vaccinations, and preventive medications. Optum Rx works alongside Mass General Brigham Health Plan to encourage the use of medications that prevent chronic conditions from worsening.
For example, members can benefit from flu shots, smoking cessation aids, and cholesterol-lowering medications covered under their pharmacy plan. These preventive initiatives aim to improve overall health outcomes and reduce long-term healthcare costs.
Comprehensive Member Education:
Education is a cornerstone of the Optum Rx Mass General Brigham Health Plan. The plan provides members with resources to better understand their medications and health benefits. These educational materials include detailed guides on medication safety, tips for managing multiple prescriptions, and insights into how pharmacy benefits work.
Additionally, members have access to webinars, FAQs, and virtual consultations with pharmacists to address any concerns. By empowering members with knowledge, the health plan helps individuals take control of their healthcare decisions and optimize their pharmacy benefits.
Frequently Asked Questions:
1. What is the Optum Rx Mass General Brigham Health Plan?
It is a partnership between Optum Rx and Mass General Brigham Health Plan to manage pharmacy benefits, starting January 1, 2024.
2. How do I check if my medication is covered?
Members can use the online formulary provided by Optum Rx to search for medications and check coverage.
3. Can I use any pharmacy?
The health plan provides a network of pharmacies where members can fill prescriptions. Use the online tools to locate participating pharmacies.
4. Are specialty medications covered?
Yes, specialty medications are included in the formulary. Members can also access specialty pharmacy services through Optum Rx.
5. How do I estimate my medication costs?
The online tools allow members to estimate the cost of medications based on their coverage and preferred pharmacy.
6. What happens if I need help with my prescriptions?
Optum Rx offers customer support to assist members with prescription-related questions and issues.
Conclusion:
The transition to the Optum Rx Mass General Brigham Health Plan marks a significant step in improving pharmacy care services for members. With advanced tools, cost transparency, and seamless healthcare integration, this partnership ensures that members receive comprehensive and efficient pharmacy benefits. If you’re part of this health plan, take advantage of the resources and support offered to manage your pharmacy needs effectively.
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