News Article

Tuesday, November 28, 2017

Reminder: Mountain States switching to OptumRx as pharmacy benefit manager effective December 1

The Mountain States PBM (pharmacy benefit manager) will be changing to OptumRx, effective this Friday, December 1, 2017. New prescription ID cards have been mailed to your home address, and you can begin using your OptumRx card on December 1. This transition from American Health Care to OptumRx should be seamless.

After December 1, visit to get the latest details about your benefits, set up your online account and get familiar with other tools. The OptumRx App makes it easy to manage your medications on the go. Or call 855-855-8748 if you have questions about your pharmacy benefits.

Whenever you pick up prescriptions, show your new ID card at your pharmacy. The OptumRx card will help you pay the lowest price for your medication.

The plan itself will remain the same and the pharmacies currently in the network will not change. You’ll continue to pay a lower co-insurance when you use any of the Mountain States Pharmacy retail locations.

Current Prior Authorizations on file with American Health Care will automatically transfer to OptumRx. Any other approvals and deductibles will also continue. Specialty drugs for complex conditions including cancer, arthritis and others will still be filled by Mountain States Pharmacy. If the drug is not available there, then contact BriovaRx, the OptumRx specialty pharmacy, at 855-4BRIOVA (855-427-4682).

If you have questions, visit (after December 1, 2017) or call HR4U at 423-431-HR4U (4748).

Here's a Q&A that will answer some of the questions team members may have:


Q What is a Pharmacy Benefit Manager (PBM)?

A – A PBM is a company that administers a prescription drug program for employers and health insurance plans. 


QWhy is Mountain States making this change?

A – We’re always open to ways to improve the benefits we offer our team members as well as cost savings to both Mountain States and our team members.


Q Who is OptumRx?

A OptumRx is a UnitedHealth Group global company offering high-quality pharmacy benefit services. 


Q – How and when will I get my new OptumRx card?

A – OptumRx will begin mailing cards to your home address in early November. The card will arrive in a white envelope with the return address showing Mountain States Health Alliance, Corporate Human Resources.


QWhen will I begin using the OptumRx card?

A – Begin using your OptumRx card on December 1, 2017. Continue using your American Health Care card through November 30, 2017.


QHow will my pharmacy benefits change with OptumRx?

A – The pharmacy benefits are not changing. The only change is a new ID card.


Q Will there be changes to the list of Maintenance drugs (the drugs that do not apply toward deductible)?

A – There are no changes to the current Maintenance List (available on the Benefits site/Health/Prescriptions Drugs from the Pulse page)


QWhat if I have already met my deductible or a portion of it with American Health Care?

A – Any deductibles you have met with AHC and/or BCBS this plan year, since July 1, 2017, will transfer to OptumRx. The pharmacy plan and medical plan share the deductibles every night to stay updated.