The need for transparency with pharmacy benefits
The array of challenges faced by sponsors of the pharmacy benefit are constantly evolving. To help plan sponsors get a sense of the emerging options available to help them, host Scott Draeger from Optum Rx welcomed leaders of innovation and strategy, Mike McGinnity and Sid Sahni, to discuss the current state of innovation in pharmacy care services on the latest episode of the Pharmacy Insights Podcast.
Read on for edited excerpts of their conversation or listen to the full podcast episode.
Scott: One of the trends we're hearing a lot about in the marketplace and that's the need for transparency. Mike, can you tell us how Optum Rx approaches this?
Mike: Transparency is an important and often misrepresented or misunderstood subject in our marketplace.
Given the fiduciary responsibilities of plan benefit sponsors, it's important for us to equip and enable our clients with the data and information they need to uphold their obligations. At its essence, transparency is about access to information. This includes information for all stakeholders within the pharmacy benefit ecosystem, including members, pharmacies, providers, clients and consultants.
For our clients and consultants, transparency is access to our independent Pharmacy & Therapeutics (P&T) Committee, allowing them to see the decisions we make about which drugs should be on, could be on, or should not be on a formulary. They have full audit rates, so all of the terms and conditions within our contracts can be validated through independent third parties.
For our members, transparency includes access to all sorts of information through the client portals, including which drugs are covered and the price of the covered drugs. Does their drug require prior authorization and what are those requirements, and can they initiate it? It includes knowing which pharmacies they can go to, and which pharmacies offer them the best deal.
We provide them with all this information online and guide them around things such as copay cards. So, if there are manufacturers sponsored ways for them to reduce their out-of-pocket costs, they can get that information as well.
For our providers, one way we provide them with transparency is through PreCheck My Script (PCMS), which gives them formulary and utilization management information right in their workflow. It provides real-time cost information and covered medications. This information is similar to what members would see in the portal. It shows if a prior authorization is required and it can be initiated immediately through the electronic prior authorization system. It also lists clinically appropriate alternatives to a given drug, so a provider can choose to prescribe a different therapy that doesn't require prior authorization and circumvent that entire process.
Scott: Sid, could you follow up and add if there are any new transparency solutions plan sponsors should be aware of?
Sid: A commitment to transparency is not new or transient at Optum Rx. It is the core of how we choose to operate the next step in our ongoing commitment.nxiety and depression continue.