New in 2026: Optum Rx and Prime Therapeutics
Check back frequently for the latest updates.
Our Medicare Advantage's pharmacy benefit manager (PBM) will become Optum Rx on January 1, 2026
As health care changes at a rapid pace, Mass General Brigham Health Plan continues to innovate and build on our total cost of care model. To create lasting value for our clients and members we serve now and, in the future, we are changing our Medicare Advantage's pharmacy benefit manager (PBM) to Optum Rx. Making pharmacy care more affordable, accessible, supportive, and personal for our members is a shared goal with Optum Rx.
FAQs about Optum Rx
Optum Rx met critical financial and operational performance indicators that will drive the most value for our members.
Optum Rx will be performing review of prior authorization for non-specialty pharmacy benefit medications.
Prime Therapeutics will review certain Part B medical drugs. More information can be found on the Prime Therapeutics FAQ page.
Optum Rx takes effect on January 1, 2026.
All existing authorizations will be transferred from the current pharmacy benefit manager (PBM) to Optum Rx.
For Part B and D coverage determinations, please submit to Optum Rx. For certain Part B medical drugs, please refer to the Prime Therapeutics FAQ.
For more information, please visit https://professionals.optumrx.com/
Members will have the option of having their existing mail order prescriptions with refills transferred to Optum Home Delivery or remaining with the in-network mail order pharmacy they're currently using.
Effective January 1, 2026, Mass General Brigham Medicare Advantage MAPD, EGWP, PDP, and SCO & One Care lines of business will utilize Optum Rx as their PBM
Members can visit MGBAdvantage.org/plans/rx-information for information regarding this change.
Yes, members will be notified by Optum Rx and Mass General Brigham Health Plan.
Yes, members will be receiving new ID cards.
Optum Rx offers an extensive national Pharmacy network including most major chain pharmacies, grocery store pharmacies, and many independent pharmacies.
FAQs about Prime Therapeutics
For more information, please visit our Prime Therapeutics FAQ page.
Never miss an update
Be the first to get the latest news, tips, and information when you subscribe to our provider Administrative Newsletter.
© 2025 Mass General Brigham Health Plan, Inc. All Rights Reserved.
Mass General Brigham Health Plan includes Mass General Brigham Health Plan, Inc.
and Mass General Brigham Health Insurance Company