(soft music)
With specialty medication spend high
and on the rise,
cost management solutions are critically needed
for plan sponsors.
To meet this challenge,
we are applying our pharmacy expertise
to implement cost management strategies
to specialty medications traditionally covered
on the medical benefit.
One of these strategies is
called the MedicalRx Specialty Provider Network.
It's an entirely new, innovative way
to maximize specialty medication savings for plan sponsors.
Key to the network are contracted medical providers
who administer clinically appropriate, infused
or injected specialty medications.
The MedicalRx Specialty Provider Network
enables these providers to bill medications
and administrative services to Optum
under a new fee schedule or a contracted rate.
How does that help?
Let's compare the current system to our new approach.
Today, providers deliver therapy and bill the medical care
and the infused or injected medications
under the patient's medical benefit.
Medical benefit management can result in unpredictable costs
and lacks the rigor necessary
to adequately control medication costs.
Plus, claims are less precise
than traditional pharmacy claims.
With the MedicalRX Specialty Provider Network,
the provider delivers the same therapy
and bills Optum for the cost of the medication
and administration,
which is converted to national drug codes or NDCs.
This enables us to employ our pharmacy expertise
in managing medication costs in a new space.
Network agreements control costs and empower providers.
They help standardize reimbursement rates across providers
and sites of care, whether it is the hospital,
home infusion, infusion center,
or physician's office.
And it's good for the administering providers too.
They maintain independence including the ability
to purchase the medications where they see fit,
which allows providers
and plan sponsors to take advantage of class
of trade purchasing value.
This helps provide a better experience while managing costs.
They submit their claims for the medications, materials,
and service together
and are reimbursed at a controlled, fair market rate.
This ensures providers receive prompt
and predictable payment, up to four weeks faster
than with the typical medical claims billing process.
For patients, the goal is the same access,
same quality care, and a better overall experience.
The MedicalRx Specialty Provider Network drives results
for plan sponsors
and with the continued management of these medications,
they will benefit from additional value over time.
The MedicalRx Specialty Provider Network is a one
of a kind solution.
It guarantees providers receive prompt
and predictable payment.
It ensures patients receive high quality, affordable care.
And it helps plan sponsors lower costs
with projected savings of up to $1.38 per member, per month.
A win for the provider, patient and plan sponsor.