WEBVTT

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Pharmacy Benefit Managers,

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PBMs, like Optum Rx,

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serve plan sponsors by offering

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prescription drug benefits
to their members.

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Price negotiation

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is a critical PBM function
since only drug manufacturers

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have the ability to set, raise,
or lower the cost of their products.

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We can negotiate 
on behalf of our clients

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so they and their members

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can access the drugs they need
at the lowest possible price.

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For example, the new weight loss

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and diabetes medications
known as GLP-1s

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are notoriously expensive,

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but drug makers concede that PBM
price negotiations have reduced

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GLP-1 prices by approximately 60%.

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We deploy a comprehensive,

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integrated approach
to ensure all agreements made

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throughout the distribution
chain seamlessly combine

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at the pharmacy counter.

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That means members receive

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the medications they
need at the price

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their plan sponsor agreed to.

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Another critical role
for PBMs is managing

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the cost of specialty medications.

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While they represent only 1-2%

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of pharmacy claims
they account for over

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50% of employers’
total prescription spending.

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And while some vendors
might advocate carving out

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specialty drugs from your plan.

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Being accountable 
for the process end-to-end,

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including specialty drugs
also helps eliminate drug waste

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while lowering
the total cost of care.

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For the most expensive
new biologic drugs

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we are leading the industry

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with innovative ways
to encourage the use

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of biosimilar versions,

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which cost less but are
just as effective

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as their branded counterparts.

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Finally,
for the most expensive drugs,

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like gene therapies costing well
over $1 million per treatment,

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we offer risk protection plans

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to protect clients
financially and ensure

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members have continued access.

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In short, negotiating drug
prices is only the beginning

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of what a PBM can do.

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Our real task is to translate

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these raw prices
into a practical plan

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that clients can use to help
deliver superior clinical outcomes

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at the lowest possible cost.