New in 2024: Optum Rx and Specialty Fusion

Check back frequently for the latest updates.

Our Pharmacy Benefit Manager (PBM)
will become Optum Rx on January 1, 2024

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 pharmacy vendor 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

FAQs about Specialty Fusion

  • What is the difference between Optum Rx vs. Specialty Fusion?

    Specialty Fusion is a system that integrates medical and pharmacy benefits into a single platform, so you can streamline your process while gaining full visibility to specialty trends. Connect patients and providers with the right treatments at the optimal cost—faster than ever. Optum Rx is the pharmacy benefit manager that will be administering the pharmacy benefit and performing prior authorization review for non-specialty pharmacy benefit medications.

  • What products will be using Specialty Fusion?

    The Commercial and Medicaid lines of business will be transitioning to Optum Rx. Excluding Medicare Advantage.

  • What will happen to my existing authorizations?

    All existing authorizations will be transferred to Specialty Fusion.

  • Will I need to use a different platform to submit my authorizations electronically?

    Electronic requests can be submitted to Specialty Fusion through the Mass General Brigham Health Plan Provider Portal beginning January 1, 2024. Select Specialty Fusion link to complete authorization. 

    Starting January 1, 2024, please see for information on how you should submit requests. Changes may occur throughout the year. *  

    Optum SSO


    PBM Change Impacts
    Commercial/Exchange and MassHealth

      Before 01/01/2024 Starting 01/01/2024
    Pharmacy Benefit Manager

    CVS Caremark

    Optum Rx
    Specialty Pharmacy CVS Specialty  Specialty Fusion
    Mail Order Services CVS Caremark Mail Service Optum Rx Home Delivery
    Formulary Management Mass General Brigham Health Plan Mass General Brigham Health Plan
    Non-Specialty Prior Authorization Review* CVS Caremark

    Optum Rx

    Phone: 800-711-4555

    Fax: 844-403-1029

    Non-Formulary Prior Authorization Review (Specialty & Non-Specialty) CVS Caremark

    Optum Rx

    Phone: 800-711-4555

    Fax: 844-403-1029

    Specialty Prior Authorization Review (Medical) NovoLogix

    Specialty Fusion

    Phone: 877-519-1908

    Fax: 855-540-3693
    Specialty Prior Authorization Review (Pharmacy)* CVS Caremark

    Specialty Fusion

    Phone: 877-519-1908
    Fax: 855-540-3693

    Appeals and Grievances  Mass General Brigham Health Plan Mass General Brigham Health Plan


  • Who do I contact if I am having issues with the Specialty Fusion website?

    If you have any technical problems or comments, please contact Specialty Fusion at:

  • Will there be provider trainings for Specialty Fusion?

    In the coming weeks, we will partner with Optum to present web orientation sessions designed to assist you and your staff with the new prior authorization portal. You are invited to attend the session best suited to your specialty. We will also record and post the sessions on this page. 

    During these sessions, we will discuss in detail the prior authorization requirements for Mass General Brigham Health Plan members and how to navigate the Optum platform. We encourage you to attend to ensure you understand the new prior authorization process.


  • How can I sign up for Specialty Fusion provider trainings?

    Registration information coming soon! Dates and times for the two sessions are below

  • Where can I find more information about Specialty Fusion?

    For more information, please visit

Provider trainings for Specialty Fusion


  Session 1: December 12, 2023 10:00 AM EST 11:00 AM EST Register here
Session 2: December 14, 2023 4:00 PM EST 5:00 PM EST Register here


Never miss an update

Be the first to get the latest news, tips, and information when you subscribe to our provider Administrative Newsletter.