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Specialty Guidance Program

The Optum® Specialty Guidance Program (SGP) helps clients control specialty drug costs. It also gives providers evidence-based, payer-compliant clinical guidance to manage complex conditions effectively.

SGP includes:

  • Online prior authorization portal and guideline library
  • Digitized clinical policies for over 50 specialty conditions
  • Ability to support all specialty drugs

Data management and analytics 

  • 14M+ data points collected with 1M+ data points for clinical guidance

Optum expertise

  • Over 18M lives managed through the program

Proven outcomes

  • Provider Net Promoter Score: 64
  • 61% of requests entered by provider through SGP website
  • 91%+ preferred product adoption

SGP focuses on specialty non-cancer conditions while Cancer Guidance Program (CGP) focuses on cancer conditions. 

Quick facts

  

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Rising global spend

$505B projected specialty medicine spend by 20232

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High cost

$84K–$136K average cost of a specialty drug in 20203

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Increasing number of specialty drugs

$1,276 projected per member annual specialty spend by 20234

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Additional insight

2x medical knowledge doubles every 73 days4

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Sources

  1. IMS Health and National Healthcare Expenditure data and Optum PBM 2017 claims.
  2. EvaluatePharma. Orphan Drug Report 2019. evaluate.com/thought-leadership/pharma/evaluatepharma-orphan-drug-report-2019. April 25, 2019. Accessed June 5, 2020.
  3. PR Newswire. Global $568 billion specialty pharmaceuticals market to 2026: leverage the changing face of specialty pharmacy industry with flat world solutions. prnewswire.com/news-releases/global-568-billion-specialty-pharmaceuticals-market-to-2026-leverage-the-changing-face-of-specialty-pharmacy-industry-with-flat-world-solutions-300915411.html. September 10, 2019. Accessed June 5, 2020. 
  4. Magellan Rx Management. Employer Market Insights Report, 2018. magellanrx.com/documents/2019/03/employer-market-insights_2018.pdf/. Accessed June 5, 2020.