As drug costs continue to rise and outcomes remain a top priority, plan sponsors are under pressure to do more with their pharmacy benefit.
That’s where we can help, with targeted solutions that drive measurable results. These are strategic levers that help you:
While not every client needs every tool, here are 3 you should consider including in your portfolio.
With specialty medications now accounting for over 50% of total drug spend, plan sponsors are actively seeking innovative solutions. Approximately 40% of commercial clients have adopted a copay accumulator program1, while 28% have either adopted or are considering an alternative funding program.2 Although these approaches may produce short-term savings, they lack strategic integration within the broader pharmacy benefit.
That’s why we developed the Specialty Standards program — a forward-thinking solution to reconfigure the benefit design around specialty medications.
Specialty Standards delivers immediate cost savings by modernizing the benefit through:
Unlike carve-out models that disrupt member experience, Specialty Standards operates entirely within the pharmacy benefit, ensuring a seamless member experience — and is backed by a 3:1 ROI guarantee.
Polypharmacy, defined as taking five or more chronic prescription medications, is increasingly common and can pose significant health risks. There are many reasons why people can accumulate extra prescriptions. In some cases, it’s simple inertia as medications prescribed for temporary conditions are not discontinued once the condition resolves.
While polypharmacy is most prevalent among those aged 65 and older, workers as young as age 40 are also taking five or more prescription drugs each day.3
Each additional medication introduces a 7-10% increased risk for an adverse drug event, raising serious safety concerns. These risks lead to increased medical costs that contribute to the estimated $177B in rising health care costs in the U.S.4
The Optum Rx Polypharmacy Value Management program has dedicated clinical pharmacists who talk members through a prescription checkup program that identifies ineffective or unsafe treatments. Then, with the member’s permission, we notify their providers about opportunities to stop unnecessary drug use.
While any kind of drug could be implicated in polypharmacy, specialty medications like Humira®, Ozempic® and Dupixent® reflect the highest plan savings from the program.5
The program alters a person’s medication regimen in partnership with their care provider, based on how their body responds to a medication, and other clinical information such as safety alerts. Providers can take action by stopping or changing treatment.
The results are gratifying:
Up to 3:1 guaranteed return on investment (ROI) on all pharmacy savings.6
The Optum Rx Polypharmacy Value Management program provides a common platform where pharmacists, members, and providers work together to ensure that each member is taking the right medications.
Formularies are the backbone of effective — and cost-effective — pharmacy care services. They help support the care quality, medication access and cost considerations that our clients and their members need.
Optum Rx relies on methodical, evidence-based decisions to drive effective formulary strategies. However, even the best formulary needs to be followed in order to be effective, and that’s not always the case.9
One study tracked nearly 10 million prescriptions over two years and found widespread use of potentially less appropriate drugs.10 Ideally, more conservative prescribing habits could lead to better patient outcomes and lower costs. But how?
The Optum Rx Provider Detailing Hub provides data-driven support to influence prescribing at the provider and provider group level, by highlighting pharmacy spend and formulary compliance. These comprehensive data insights are logically organized to support targeted interventions and cost-saving strategies.
The Provider Detailing Hub allows you to engage prescribers directly to:
It’s now possible to get provider-level data insights and trends on formulary compliance, lowest net cost drug strategies, clinical quality performance and other provider prescribing patterns. Provider Detailing Hub can be adopted as a platform-only to plug into client strategies, or be combined with Optum Rx Academic Detailing Services.
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Specialty drug spend is a “top threat” to employer-provided benefits. Discover sustainable savings with your existing Optum Rx plan.
Millions of workers at risk due to overprescribed drugs.
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From predicting drug trend to earlier fraud protection, see how we’re leveraging AI to improve operations for clients and members.
