How do pharmacy benefit managers work?

[UPBEAT MUSIC STARTS]

[A white background with the Optum Rx logo in the center. The O from the logo expands outwards off the edges of the screen, transforming it. Text appears.]

On-screen text: Pharmacy Benefit Managers.

NARRATOR: Pharmacy benefit managers…

[The screen clears and a graphic of a pill bottle and a paper bag with an Rx logo on it appear from the right-hand side. Text appears.]

On-screen text: PBMs

NARRATOR: PBMs, like Optum Rx, serve plan sponsors by offering prescription drug benefits to their members.

[The paper bag and text leave the screen, and the pill bottle moves closer. A yellow arrow with a dollar sign on it extends from the right side of the pill bottle. An orange arrow with a dollar sign on it extends from the right side of the pill bottle.]

NARRATOR: Price negotiation is a critical PBM function…

[The arrows disappear, and the pill bottle is joined by a receipt.]

NARRATOR: …since only drug manufacturers have the ability to set, raise, or lower the cost of their products.

[The pill bottle and receipt slide off-screen and two hands appear from either side of the screen, one skin-colored and the other orange. They reach towards each other and shake hands.]

NARRATOR: We can negotiate on behalf of our clients so they and their members…

[The hands leave the screen, and three pill bottles slide on. A white arrow extends from the top of the screen downwards with text on it.]

On-screen text: Lowest possible price.

NARRATOR: …can access the drugs they need at the lowest possible price.

[They slide off screen and three different types of syringes in different colors slide on-screen. Text appears.]

On-screen text: GLP-1s.

NARRATOR: For example, the new weight loss and diabetes medications known as GLP-1s are…

[The text disappears and an orange price tag slides on screen, coming to hang off the bottom syringe.]

NARRATOR: …notoriously expensive, but drug makers concede that PBM price negotiations have reduced…

[The syringes slide up leaving the screen and leaving behind the price tag. The tag split in half, revealing text beneath the detached section.]

On-screen text: 60%.

NARRATOR: …GLP-1 prices by approximately 60%.

[The price tag and text slide off-screen and are replaced by new text, along with images of three pill bottles, a package with an Rx sticker on the side and a delivery van. The three images are connected by arrows pointing from left to right.]

On-screen text: Comprehensive, integrated approach.

NARRATOR: We deploy a comprehensive, integrated approach to ensure all agreements made throughout the distribution chain…

[The text disappears and all the images merge together, transforming into a small building with an orange awning which has the Rx logo on it.]

NARRATOR: …seamlessly combine at the pharmacy counter.

[The building slides off and is replaced by a top-down view of a pill bottle with its lid off. Inside is a single pill.]

NARRATOR: That means members receive the medications they need…

[The pill bottle disappears, and dollar coins appear.]

NARRATOR: …at the price their plan sponsor agreed to. Another critical role for PBMs…

[The dollar coins disappear and graphics of an IV bag, pills, tablets, a pill bottle and syringe slide on-screen, along with text.]

On-screen text: Specialty medications.

NARRATOR: …is managing the cost of specialty medications. While they represent…

[The text slides off-screen and the graphics shift to the left-hand side of the screen. Text appears on their right.]

On-screen text: 1-2% of pharmacy claims.

NARRATOR: …only 1-2% of pharmacy claims they account for over…

[The text changes.]

On-screen text: +50% of total prescription spending.

NARRATOR: …50% of employers’ total prescription spending. And while some vendors might advocate carving out…

[The image and text leave the screen and a graphic of an orange box with an Rx logo and two pill boxes inside appears and the medical equipment appears in the space above the box.]

NARRATOR: …specialty drugs from your plan. Being accountable for the process end-to-end, including specialty drugs…

[The medical equipment flies into the box.]

NARRATOR: …also helps eliminate drug waste…

[The box and its contents slide off-screen. An arrow extends down from the top of the screen, then fills with dollar coins and text appears.]

On-screen text: Lowering cost of care.

NARRATOR: …while lowering the total cost of care.

[The text and arrow leave the screen, and an IV bag appears next to a white circle which fills with three dollar signs.]

NARRATOR: For the most expensive new biologic drugs we are leading the industry with innovative ways to encourage the use of…

[The IV bag and circle slide to the left and are joined by another orange IV bag and a circle which only has one dollar sign inside.]

NARRATOR: …biosimilar versions, which cost less but are just as effective as their branded counterparts. Finally, for the most expensive drugs…

[The IV bags and circles leave the screen and a graphic of a dual strand of DNA slides across to the right-hand side. Text appears beside it.]

On-screen text: Gene therapies.

NARRATOR: …like gene therapies costing…

[The DNA strand slides left, clearing the text. New text appears on the right.]

On-screen text: $1 million+ per treatment.

NARRATOR: …well over $1 million per treatment…

[The DNA and text leave the screen and are replaced by a graphic of a document with a folder behind it and an orange circle with a dollar sign at the bottom of the page.]

NARRATOR: …we offer risk protection plans to protect clients financially…

The document slides off-screen and is replaced by a graphic of a woman sitting in an armchair with an IV connected to her arm. A small cat and a plant are next to the armchair.]

NARRATOR: …and ensure members have continued access.

[The image leaves the screen and the pill bottle with the yellow and orange arrows returns. Text appears below it.]

On-screen text: Negotiating drug prices.

NARRATOR: In short, negotiating drug prices is only the beginning of what a PBM can do.

[The pill bottle and text leave the screen, and three circles appear in a triangular formation. One circle has a symbol of three progressively larger bars inside it, one has a dollar sign and one has a plus symbol.]

NARRATOR: Our real task is to translate these raw prices into a practical plan…

[The three circles move closer together, overlapping on the inner section to form a pie chart shape.]

NARRATOR: …that clients can use to help deliver superior clinical outcomes at the lowest possible cost.

[The O from the Optum Rx logo closes in from the edge of the screen, turning the background white. It comes to rest in the center of the screen before shifting left and being joined by the other letters of the logo.]