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On February 6, Elevate sent a notice to its members notifying them of an amendment to its PSAO agreement with OptumRx. The amendment, among other things, will introduce an arbitration clause for the first time. Elevate had successfully resisted the inclusion of an arbitration agreement for several years. However, OptumRx made the inclusion of the arbitration provision a condition of doing business with OptumRx’s 61 million lives.
As a part of the amendment, Elevate has agreed with Optum to seek its members’ signature to an acknowledgement of the amendment by April 1, 2025. Whether or not a pharmacy signs the acknowledgement, the amendment, including its arbitration clause, will take effect on April 1, 2025. The clause will require your arbitration for any dispute a pharmacy has with OptumRx even if the dispute arose before April 1, 2025. Please note that if a pharmacy fails to sign the acknowledgement by April 1, OptumRx may, in its discretion, terminate the pharmacy from its network and still bind the pharmacy to the arbitration clause.
Therefore, the only way for a pharmacy to preserve its right to avoid arbitration for claims against OptumRx that originated before April 1, 2025, is by either providing OptumRx written notice of the dispute or by asserting the claim before April 1. You should review the amendment and consult with your legal counsel about its provisions and your rights with respect to any possible claim against OptumRx before April 1. Those that are part of NCPA’s TRUST LLC should visit the login portal at www.FightPBMS.com for more information on how this amendment may impact your rights.
The only other way to avoid the effect of this arbitration clause is to cease being in-network with OptumRx by informing Elevate to transition your store to Elevate Provider Network’s NCPDP chain code 626 which does not hold contracts with OptumRx (terminating from the Elevate network altogether may not suffice since termination requires at least 60 days prior notice which can only take effect after April 1, 2025). We are unaware of any other PSAO that has not already agreed to an arbitration clause with OptumRx and all direct contracts with OptumRx require arbitration. Elevate advises to contact the Elevate Provider Network Helpdesk at 888-880-1388 or Elevate@AmerisourceBergen.com with any questions.
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