How does the Optum Rx Pharmacy & Therapeutics Committee work?
For our clients, we’re committed to offering transparent, alternative pricing models that align incentives and focus on the lowest net cost of drugs. We continue to host the industry’s most transparent, independent Pharmacy & Therapeutics (P&T) Committee, providing evidence-based review and appraisal of new and existing medications and their place in therapy.
The P&T Committee consists of independent, practicing physicians and pharmacists in various specialties — none of the voting members are part of the Optum Rx team. This 12-member committee meets on a quarterly basis to discuss industry, clinical and company standards, and to evaluate and review new and existing medications, as well as their appropriate place in therapy.
The rigorous, evidence-based review process provides customers with the information they need to make the right choices for their unique circumstances. We invite all clients and pharmacy consultant partners to attend these meetings. We are focused on delivering stakeholders the lowest cost for prescription drugs while helping improve health outcomes.
DR. SUMIT DUTTA: Hello, I'm Dr. Sumit Dutta, Chief Medical Officer of Optum Rx. And I'm joined today by two of my colleagues, Dr. Ana Bhatnagar, and Dr. Sina Carlson. Ana, can you introduce yourself to the audience?
DR. ANA BHATNAGAR: Sure. I'm Ana Bhatnagar. I am an OBGYN, who was in private practice. I worked at the FDA for a few years, and then I transitioned over to United Healthcare and did policy work for 10 years prior to having the privilege to come to Optum Rx last year.
DR. SUMIT DUTTA: It's great experience. Sina, I know we've worked together for 10 years. Can you tell folks a little bit about yourself?
DR. SINA CARLSON: Yes. So Sina Carlson, I am the Vice President of Drug Intelligence, here at OptumRx. I've been in the PBM industry for over 20 years now, in a variety of roles, all primarily clinical, but a little experience in account management as well. And I've spent about the last 10 years with Optum Rx, focusing on drug information and P&T services.
DR. SUMIT DUTTA: That's a great experience as well. Well, I'm sure both of you will agree that the clinical functions of a pharmacy benefit management company are among the most important functions, certainly to protect patients. And I think that's why we have so much clinical expertise within our department. Probably our audience would like to know that there are thousands of pharmacists, physicians, and nurses that work within OptumRx that focus on the issues that we're going to be talking about. Specifically, I think one of the most important aspects is our independent pharmacy and therapeutics committee. Can you tell our listeners a little bit more about our P&T committee?
DR. ANA BHATNAGAR: So our committee is a group of practicing physicians and pharmacists that don't work for OptumRx, but they're the ones that evaluate the evidence base for new medications and help inform how we think about them, how we designate them on our formulary, and what we do for utilization management.
DR. SUMIT DUTTA: And I would point out one of the things that's important, is they don't consider the cost of drug when they're evaluating. They only consider the quality of the science.
DR. ANA BHATNAGAR: Correct.
DR. SUMIT DUTTA: Sina, I have a question for you.
DR. SINA CARLSON: Sure.
DR. SUMIT DUTTA: We have thousands of drugs on a formulary, and your team evaluates every P&T committee, hundreds of drugs. How do we manage that with just 12 members on the P&T committee?
DR. SINA CARLSON: That's a great question. So yes, we have these 12 core members that have a variety of specialties, but even in addition to those, we also have opportunity
to speak to additional independent experts that are practicing clinicians as well. And that's all done by the work that my team pulls together in their drug monographs and class reviews. So the review itself is evidence-based. And I'm biased in nature. It's my team of pharmacists that are evaluating the evidence and the strength of the evidence, to bring forward to these external experts, our P&T committee, to evaluate and make the decision as to whether a drug has a therapeutic benefit or potentially more risks than benefit for our patients.
DR. SUMIT DUTTA: It's these pharmacists and physicians, they don't have to be expert in everything. Your team provides the expertise, along with the consultants. But we want them, then, to make a reasonable decision for patients, with the patient first, and your team does a great job at that. Thank you.
DR. SINA CARLSON: Thank you.
DR. SUMIT DUTTA: The one thing that I've learned in my nearly two decades of working in the pharmacy benefits management industry, is that it's rarely black and white when you're talking about drugs. A lot of people that I meet think that when a drug is FDA approved, it's a hundred percent approved. But Sina, I know you know that the FDA panels sometimes disagree. Can you tell us a little bit about how we monitor that?
DR. SINA CARLSON: Yes, absolutely. So our pipeline and drug surveillance team does an excellent job at monitoring the drug pipeline, meaning before these products are FDA approved. And one of the key roles they play is actually listening to the FDA experts talk about the drugs and the evidence, so that they can get a firsthand perspective of what the thinking is around the product and what the evidence is at least starting to tell us. And that helps to inform our internal process that ultimately goes to P&T.
DR. SUMIT DUTTA: Thank you. That's an excellent point. Ana, I was thinking about how so many drugs have both benefits and risks. Like I think about antibiotics and how useful they are for people, but if you take too much of it, there's resistance. How do we think about risks and benefits as it relates to our P&T deliberations?
DR. ANA BHATNAGAR: We have a deep focus on safety and we really think about that patient first. And when we look at the evidence, that safety consideration and the risks of taking the drug versus the benefit from the therapy, itself, is a deep consideration and a complex one. I know that Sina and team spend a lot of time and a lot of discussions, as she noted, with external experts and internally, as well as the P&T.
DR. SUMIT DUTTA: I actually enjoy watching the discussions because the debate that our clients see, really makes it clear how complex these issues are. And when the work is done, your team does the expert work. We have independent doctors and pharmacists making decisions. We know that at the end, we're making the best decision for patients. Ana, Sina, and your teams, thank you for all the effort that you do to put patients in the center of what we do.
DR. ANA BHATNAGAR: Thank you for having us, and the opportunity to speak about the work that we do and the great patient focus we have.
DR. SINA CARLSON: Thank you Sumit.
DR. SUMIT DUTTA: Listeners, I hope you are left today with three important aspects of our work: the clinical rigor, the integrity, and the transparency in which we do our work. Our clients, we encourage you to come and watch our Pharmacy and Therapeutics Committee in action, and I'll look forward to seeing you there in person. Thank you.
Speaker bios
As chief medical officer at Optum Rx — a national pharmacy care services company serving 59 million Americans — Dr. Dutta leads all clinical programs focused on achieving better health outcomes for patients, lowering costs for the healthcare system and improving the healthcare experience for consumers. Dr. Dutta has a team of 5,000 pharmacists and pharmacy technicians that help patients every day learn how to take their medications, avoid harmful drug interactions and manage their chronic conditions.
Dr. Dutta brings over three decades of experience in healthcare. He has been with UnitedHealth Group since 2015 and joined Optum Rx as part of the Catamaran acquisition. Before joining Catamaran, Dr. Dutta led the Quest Diagnostics India subsidiary, driving growth in the diagnostics, employer and clinical trials laboratory testing markets. Dr. Dutta previously served in various senior executive roles at the pharmacy benefits manager, Medco, including President of Accredo NovaFactor and chief medical officer of Medco’s health plans division.
Dr. Dutta is one of several leaders overseeing the Optum Rx Inclusion & Diversity (I&D) initiative, which advocates for inclusive practices within Optum’s workforce as well as encourages the creation of programs that advance inclusion, diversity and health equity in the communities Optum Rx serves.
Dr. Dutta earned his medical degree from Michigan State University and his Master of Business Administration from New York University, Stern School of Business. He completed his internship at the University of Chicago Hospitals and Clinics and his residency at Rush Medical Center, practicing Internal Medicine at New York University Health Center.
Dr. Bhatnagar has accountability for clinical strategy including pipeline development, clinical formulary support, drug intelligence and utilization management. Additional responsibilities include communicating the clinical value proposition to existing and potential clients and improving the clinical quality of services in Optum Rx.
Throughout her over 10 years of experience within managed care, Dr. Bhatnagar was focused on pharmacy and medical policy, most recently at UnitedHealthcare (UHC) as the Chair of the Pharmacy and Therapeutics committee. Prior to UHC, she was a medical officer at the Food and Drug Administration Office of New Drugs and served as an expert for labeling, review of new drug applications and representative for collaborative public health programs with partner agencies.
Dr. Bhatnagar’s clinical specialization is in Obstetrics and Gynecology. She holds an undergraduate degree from Yale University and a medical doctorate from University of Cincinnati School of Medicine. She completed her residency at Eastern Virginia Medical Center.
Dr. Sina Carlson is the Vice President, Drug Intelligence at Optum Rx. In this role, she has responsibility over all Pharmacy & Therapeutics Committee processes and drug information services.
Dr. Carlson has been involved in managed care for over 20 years. Prior to joining Optum Rx, she held positions with other pharmacy benefit management firms working in drug information, formulary, prior authorization, operations, client management and residency programs. She also has experience as a retail and home delivery pharmacist.
Dr. Carlson holds a Doctor of Pharmacy degree from Midwestern University, Chicago College of Pharmacy. She is a registered pharmacist in Pennsylvania and Illinois. Dr. Carlson is a member of the Academy of Managed Care Pharmacy (AMCP).