This year has proven to be one of significant clinical importance—from successful COVID-19 vaccine distribution to a robust drug development pipeline approaching a new record high.
As pharmacies continue to be the most frequent touchpoint in health care, clients, payers and providers are looking to the health care industry for solutions that improve health outcomes for patients while lowering costs.
As we approach the fourth quarter, OptumRx examines several areas that have impacted our industry and forecasts where we are headed:
Drug affordability
Stakeholders across health care are putting a concerted effort toward lowering drug costs for patients. OptumRx research shows when out-of-pocket costs exceed $25 for a new prescription, that prescription will be abandoned nearly 30% of the time, leading to poor health outcomes and higher costs.
To address this, OptumRx launched its Critical Drug Affordability program that provides critical medications, such as anticoagulants and HIV treatments, to consumers for $25 or less.
Increase in high-cost therapies
Further worsening affordability concerns are the development of more “Orphan” and “Ultra Orphan” drugs approved with very high price tags. Costs are not limited to the drugs but also include high-touch medical care needed before, during, and after therapy administration.
Optum is focused on providing advanced solutions, such as its Orphan Drug Management Program, which provides ongoing personalized support for patients who take one of 19 orphan drugs we’ve identified as having the greatest opportunity for clinical intervention and cost savings.
Similarly, for disease areas such as oncology, our integrated specialty drug management program (which provides a cross-functional team working directly with patients who are receiving therapies that are known to cause a lot of side effects) has resulted in a 79% reduction in hospitalizations and ER visits and up to $8.1 million in potential cost avoidance to clients.
Enhancing virtual care for the long term
Even as longtime COVID-19 pandemic restrictions lift, telemedicine, prescription home delivery and virtual care will continue to be a priority given the convenience and cost savings associated. Importantly, pharmacy benefit managers are taking critical steps to ensure patients receiving care from home are being treated holistically given the physical barriers of virtual care.
For example, members who call OptumRx are screened for social isolation and referred to Optum Behavioral Health. Rally, Optum’s digital health platform, also provides members access to a disease prevention program that helps members achieve sustainable lifestyle changes which over time help decrease the risk of developing hypertension, high cholesterol, diabetes, and other chronic diseases.
Applying COVID-19 lessons to treatment
The pandemic highlighted health care access issues; understanding and solving for the social determinants of health is an ongoing priority within the industry to ensure optimal health care for everyone. OptumRx working to continuously increase access to its FirstLine Benefits™ Program, which offers a suite of supplemental food and over-the-counter OTC benefits to help reduce inequities in food and essential health care items. Results showed that members who used their OTC benefits saw improvements across four key indicators including reductions in hospital admissions and ER visits.
As a pharmacy care services company located at the center of health care, we are constantly evaluating and examining the factors that pose the most risk—or greatest opportunity—to consumers and our clients. The remainder of 2021 will continue to be marked by collective efforts to lower drug costs and create hybrid care models that continue to prioritize virtual channels and improving health equity.
Sumit Dutta, M.D., is the chief medical officer of OptumRx.