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Prescriptions / Pharmacy

The following forms will help you manage your healthcare information related to services you receive through OptumRx.

What you’ll need:

  • 10-15 minutes, and
  • In some cases, your health or pharmacy benefit plan ID card

What would you like to do with the healthcare information we have about you?


Click herePDF Opens in a new window or tab for a form you can complete to request a copy of your healthcare information that OptumRx maintains.

Please note: If you need a list of the prescriptions you filled through OptumRx® Home Delivery Pharmacy, you can view and print a copy from your online account at OptumRx by logging in and selecting Claims History or by contacting customer service at the telephone number located on your health or pharmacy benefit plan ID card.


Click herePDF Opens in a new window or tab for a form you can complete to request a change to your healthcare information that OptumRx maintains.


Click herePDF Opens in a new window or tab for a form you can complete to receive OptumRx mail or phone calls at locations other than your home or to get your healthcare information in a different way. If this is an urgent request, call the phone number on the back of your health or pharmacy benefit plan ID card to make a verbal request.


Click herePDF Opens in a new window or tab for a form you can complete to change an existing confidential communication address.


Click herePDF Opens in a new window or tab for a form you can complete to limit who your healthcare information is released to or how it is used. OptumRx uses and discloses member level information only as necessary to provide services to our members and as permitted and required by law. Please note that while we will try to honor your request and will permit requests consistent with our policies, we are not required to agree to any restriction.


Click herePDF Opens in a new window or tab for a form you can complete to allow someone else to access your healthcare information or speak on your behalf.


Please send a request in writing to OptumRx, Attn: Commitment and Follow Up Team, 6860 West 115th Street, Mail Stop: KS015-1000, Overland Park, KS 66211-2457 or fax to 1-866-889-2116.


Click herePDF Opens in a new window or tab for a form you can complete to help manage their healthcare information. You will also need to provide a copy of your legal authority to represent the individual if the individual cannot sign the form.


Click herePDF Opens in a new window or tab for a form you can complete to obtain a list of who your information has been disclosed to for purposes outside of treatment, payment, or healthcare operations.


  • Via email at privacy@optum.comOpens in a new window or tab.
  • Via mail at:
    Optum
    Privacy Administrator
    MN101-E013
    11000 Optum Circle
    Eden Prairie, MN 55344
  • You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint. We will not take any action against you for filing a complaint.

Click hereOpens in a new window or tab to print a copy of the NPP outlining how your healthcare information may be used and/or disclosed.


If you are unable to find the form you need or have questions, call customer service at the telephone number located on your health or pharmacy benefit ID plan.