Pharmacy Appeals to Help Patients Get Medication Coverage

(Light music playing.)

(Title slide reading: Optum Specialty Pharmacy & Optum Infusion Pharmacy Appeals Team, Changing Dynamics in Healthcare)

The team was created in response to

the changing dynamics in healthcare.

So at that point in time, we started to see a lot of denials.

And patients having difficulty

getting access to the mediations and treatments

that they really needed.

(Title slide reading: Combined 100+ years of clinical experience across the team)

When we get a denial on a patient,

the first thing that we're going to do

is review medical polices for the insurance company.

Every insurance company is different, and

things that they ask for are going to be different

and specific to each patient's plan.

So, once we have that knowledge base,

then we focus in on what that individual patient

is experiencing, what their symptoms are,

what medications they may have tried in the past are,

and we write a letter that is specific to them.

(Title slide reading: In 2021, the teams had an 80% overturn rate after previous denial)

I called the patient, and I said, you know,

Not only did we get it approved,

but we got it approved for you for a year.

I remember saying, "That just made my day."

And the patient said, "You just made my life!"

And I get goosebumps just every time I think about it.

Because it's such an incredible feeling

to know that you had that kind of impact.

You know, it's challenging ...

and rewarding all at the same time.

(Title slide reading: Since 2018, over 10,000 patients were approved after previous denial)

We are an advocate for these patients.

We treat them ... I always think of them

as my mother, my brother, sister, father.

How would I like to be treated if I was in this situation?

And I treat my patients the same way.

(Title slide reading: Contact your Optum representative to learn how we can help with your appeals.)

(Optum logo appears.)