Controlling specialty drug costs

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With specialty medication spend high

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and on the rise,

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cost management solutions

are critically needed

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for plan sponsors.

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To meet this challenge,

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we are applying our pharmacy expertise

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to implement cost management strategies

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to specialty medications

traditionally covered

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on the medical benefit.

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One of these strategies is

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called the MedicalRx

Specialty Provider Network.

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It's an entirely new, innovative way

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to maximize specialty medication

savings for plan sponsors.

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Key to the network are

contracted medical providers

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who administer clinically

appropriate, infused

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or injected specialty medications.

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The MedicalRx Specialty Provider Network

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enables these providers

to bill medications

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and administrative services to Optum

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under a new fee schedule

or a contracted rate.

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How does that help?

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Let's compare the current

system to our new approach.

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Today, providers deliver therapy

and bill the medical care

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and the infused or injected medications

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under the patient's medical benefit.

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Medical benefit management can

result in unpredictable costs

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and lacks the rigor necessary

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to adequately control medication costs.

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Plus, claims are less precise

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than traditional pharmacy claims.

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With the MedicalRX

Specialty Provider Network,

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the provider delivers the same therapy

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and bills Optum for the

cost of the medication

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and administration,

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which is converted to

national drug codes or NDCs.

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This enables us to employ

our pharmacy expertise

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in managing medication

costs in a new space.

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Network agreements control

costs and empower providers.

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They help standardize reimbursement

rates across providers

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and sites of care, whether

it is the hospital,

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home infusion, infusion center,

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or physician's office.

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And it's good for the

administering providers too.

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They maintain independence

including the ability

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to purchase the medications

where they see fit,

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which allows providers

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and plan sponsors to

take advantage of class

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of trade purchasing value.

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This helps provide a better

experience while managing costs.

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They submit their claims for

the medications, materials,

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and service together

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and are reimbursed at a

controlled, fair market rate.

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This ensures providers receive prompt

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and predictable payment,

up to four weeks faster

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than with the typical medical

claims billing process.

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For patients, the goal is the same access,

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same quality care, and a

better overall experience.

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The MedicalRx Specialty

Provider Network drives results

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for plan sponsors

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and with the continued

management of these medications,

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they will benefit from

additional value over time.

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The MedicalRx Specialty

Provider Network is a one

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of a kind solution.

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It guarantees providers receive prompt

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and predictable payment.

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It ensures patients receive

high quality, affordable care.

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And it helps plan sponsors lower costs

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with projected savings of up

to $1.38 per member, per month.

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A win for the provider,

patient and plan sponsor.

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