The following function(s) is/are temporarily unavailable, but we expect to have it working again shortly.  If you need assistance, please call the Pharmacy Help Desk. Thanks for your patience.

  • Claims History Search

The Pharmacy eServices page is temporarily unavailable, but we expect to be back online shortly.  If you need assistance, please call the Pharmacy Help Desk. Thanks for your patience.

Medicare Part B Patient Consent Forms

Advance Beneficiary Notice of Noncoverage (ABN)

Form for patient to accept responsibility in case Medicare provider payments do not fully cover expected amounts to Optum Specialty Pharmacy. Please complete and return the form to the requesting department.

Advance Beneficiary Notice of Noncoverage (ABN) Spanish

Form for patient to accept responsibility in case Medicare provider payments do not fully cover expected amounts to Optum Specialty Pharmacy. Please complete and return the form to the requesting department.