Most individuals will not be affected by the transition from Express Scripts, their current supplier of medications, to Capital Rx as their pharmacy provider in 2024. Capital Rx will work proactively to identify members who may be impacted by a copay increase, prior authorization requirement, or medication coverage change. Additionally, Capital Rx will obtain and load current member prior authorizations that will still be effective Jan. 1, 2024, and beyond.
If you're among the few who will experience changes to your prescription coverage, you will receive communication from Capital Rx after Jan. 1 that will provide information needed to make your change as smooth as possible. You will have enough advance notice to allow you to work with your health care provider to review and select alternatives, or to submit a new prior authorization request for review. You will have until March 31, 2024, before the expiration of the continuation of therapy period, during which you can continue your current medication without new authorization.
Home delivery and specialty pharmacy options
You can receive mail order services through Optum Home Delivery.
You can manage your specialty medications at any of the Johns Hopkins Community Pharmacies or with Optum Specialty Pharmacy.
Mail order open prescription transfer support
Capital Rx will be working directly with Express Scripts to transfer eligible prescription(s) to Optum Home Delivery. This process does not include the transfer of expired prescriptions, controlled substances, or those with zero refills remaining.
Specialty medication management with Johns Hopkins Community Pharmacies
If you prefer that Johns Hopkins Community Pharmacies manage your specialty medication rather than Optum Specialty Pharmacy, call 410-288-6000.
Getting started with Optum home delivery and Optum Specialty Pharmacy
Step one: You will need to reach out to your prescriber and update your mail order and/or specialty pharmacy provider to Optum.
Set up your online account: Visit pharmacy.optum.com to register or log in. You can complete your pharmacy profile to load a payment method and set your mailing address for medication delivery.
By phone: Call Quantum Health at 844-460-2801 to speak with a care coordinator. You also can ask your health care provider to send an electronic prescription to Optum Home Delivery or Optum Specialty, whichever applies.
Managing refills or new prescriptions with Optum Home Delivery
E-prescribe (preferred): Have your prescriber send your prescription electronically to Optum Home Delivery.
Fax: Have your prescriber fax your prescription to Optum Home Delivery. Faxed prescriptions may be sent only by a doctor's office and must include patient information.
Online: Log in to pharmacy.optum.com to place an order for available refills.
Mail: Mail your paper prescription to Optum Home Delivery at 6800 W. 115th St., Suite 600, Overland Park, KS 66211-9838.
Important reminder for 2024
You will receive one medical ID card for both your medical and pharmacy benefits.