OptumRx Specialty Pharmacy
 

My wife takes a specialty drug that’s 3000 a pop. Insurance won’t cover anything until the deductible is met then it’s $75 a fill after that. The manufacturer has a program they give enough funding on a “co-pay card” which is designed to pay to meet the deductible and able to cover the fills for the year. Unfortunately but unsurprisingly optum’s stance is paying with the card doesn’t go towards anything, neither deductible nor out of pocket max. Any advice on how to try and navigate their asinine view on this? Why does it matter if I pay for it Vs the manufacturer paying?

I'd start talking to your CPO about it, and ask to get passed along to the regional HR rep. Each "region" has one, who can handle this stuff better. UHC is just paid to administer the plan and pays what Delta tells them to. Another option is the ALPA R&I person, who is very good (who isn't KB-F anymore, but been replaced by SG). PM if you want the email address for the ALPA person.