Here's What's New in 2023 for Pharmacy and Vision

Optima Health continuously looks for ways to improve benefits, services, and costs for its members.

Medicare

As part of this effort, effective January 1, 2023, our pharmacy benefit manager (PBM) is changing from OptumRx® to Express Scripts. Also, our vision services vendor is changing from EyeMed to Community Eye Care (CEC).

You can rest assured you will experience little to no disruption in services with this new partnership with Express Scripts.

Please contact Optima Medicare Member Services at 1-800-927-6048  (TTY: 711) if you have any questions or concerns.

October 1–March 31 | 7 days a week |  8 a.m.–8 p.m.
April 1–September 30  |  Monday–Friday  |  8 a.m.–8 p.m.

Medicaid

Optima Health is always looking for ways to improve benefits, services, and your member experience.

Our Medicaid plan is changing from Optum Rx® to Express Scripts, Inc. for managing your pharmacy benefits. You will continue to get your covered prescriptions at no cost to you, through our extensive national pharmacy network. View your prescription history and find pharmacies through your online member account optimahealth.com/signin or the Optima Health mobile app.

VSP Vision Care (VSP) will be your new eyecare provider starting January 1, 2023. Your vision benefits and services will not change.

We will send you an updated member ID card in the mail before the new year to reflect these changes. Continue to use your current card until the end of the year. You can begin using the new card on January 1, 2023.

If you have any questions, please call Optima Health Member Services at the number on the back of your member ID card.

Commercial

We have made the strategic decision to change our pharmacy benefit manager (PBM) from OptumRx® to Express Scripts® and our vision services vendor from Eyemed to VSP Vision Care (VSP) for all lines of business, effective January 1, 2023 (regardless of your plan effective date).

You will experience little to no disruption in services with these new partnerships. You can expect the following:

  • Seamless transition
  • We will continue to use Proprium for specialty tier 4 medications
  • Continued access to a robust national pharmacy network
  • Active pharmacy pre-authorizations and mail-order or specialty pharmacy scripts with refills remaining will be automatically transferred
  • New online pharmacy and vision portals accessible from optimahealth.com/members and the Optima Health mobile app
  • A wider selection of vision providers with more access points and several retail locations
  • Opportunity to participate in a discount program called Vision Savings Pass

All members with our pharmacy benefit included in their plan will receive a new Optima Health member ID card prior to January 1, 2023, with updated pharmacy information. To ensure your pharmacy and vision providers have the correct information, you should share your new member ID card once available. If you need to access a digital version of your member ID card, you can view a copy on the Optima Health mobile app.

Copayments and other cost-share amounts are determined by your plan benefits. If you have any questions, please contact member services at the number on the back of your member ID card.

View Commercial Group and Individual Plan FAQs.

If you're not sure if pharmacy and/or vision benefits are included in your Optima Health plan, please check with your employer or call member services.

10/24/2022

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