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Contract With OptumRx, Inc forAgreement • December 29th, 2020 • California
Basic Fraud, Waste & Abuse Audit: Optum staffs a diverse team of auditors and investigators focused on generating recoveries for, and detecting and deterring, fraud on the behalf of the client. Included Administration of OptumRx Standard Formulary: Optum bases formulary decisions on lowest net cost to provide sound clinical coverage while delivering more client savings and balancing member disruption. Included Administration of OptumRx Standard UM programs: From quantity limits to prior authorization to step therapy, Optum offers utilization management strategies that balance flexibility, savings, and member disruption.Refer to Benefit Design Forms for specific edits Included Standard Clinical Publications: Optum provides regular and timely updates relating to internal programs, CMS memos and more. Included Opioid Risk Management - Advanced Point of Sale Edits: Enhanced Drug Enforcement Agency Edit (DEA) Enhanced Concurrent Drug Utilization Review (CDUR):• Drug-Drug Interaction: O
