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.

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

All existing authorizations will be transferred to Specialty Fusion.

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 https://www.massgeneralbrighamhealthplan.org/providers/pharmacy-guidelines for information on how you should submit requests. Changes may occur throughout the year. *  

PBM Change Impacts
Commercial/Exchange and MassHealth

If you have any technical problems or comments, please contact Specialty Fusion at: optum_specialty_fusion@optum.com

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.

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

For more information, please visit https://info.optum.com/specialty-fusion