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Optum Specialty Medication Management

We take an integrated approach to controlling specialty costs by managing across both benefits and creating a seamless patient experience.


Innovative specialty pharmacy solutions

We deliberately align cost management strategies to deliver healthier outcomes and savings opportunities. The result is:

$16 PMPM plan savings

with Optum specialty management1

$1.7B highly-managed plan savings

with Optum Specialty Pharmacy2

$823.5M patient financial assistance

delivered in 20233

Smoothing cost variations on the medical side

Optum MedicalRx Specialty Provider Network helps plan sponsors control the cost of specialty drugs by standardizing fair market-value reimbursement rates for providers within the network. The solution saves plan sponsors $1.38 per member per month.4

Piggy bank savings still shot

What you can expect from Optum specialty pharmacy

We are your specialty pharmacy partner and have a shared purpose to help manage the costs of specialty medications while ensuring members get the medications they need. We do this by focusing on four key strengths.

1. Proven pharmacy management

This is foundational to any specialty strategy, and it’s what makes our cross-benefit approach so powerful. Helping plan sponsors manage utilization, avoid waste and take full advantage of market trends, that’s just the start of your savings opportunities.

2. Pharmacy care and clinical expertise

The people we serve are at the center of specialty medication management. Leveraging our analytics, technology, and clinical resources, we personalize care, collaborate with providers and help ease access for members.

3. Innovative medical management

Sometimes the most effective drug management is on the medical benefit. Aligning medical and pharmacy specialty management so closely has led to $16 PMPM savings on specialty drug spend and MedicalRx Rebates alone has reduced costs by $7.80 - $8.40 PMPM.

4. Aggressive cross-benefit management

Optum has the pharmacy and medical footprint, data and expertise to help plan sponsors and providers make more precise specialty decisions based on whichever benefit offers the greatest clinical and cost advantage.

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  1. Specialty savings book of business April 2021 on a standalone basis, not tied to the medical carrier.
  2. Clinical interventions: Optum Patient Exchange Intervention Tool, Book of Business, 8/1/20-7/31/21, Generic conversion: Optum Specialty Pharmacy BOB Data 7/1/2021 – 8/24/2022.
  3. Optum Specialty Pharmacy Patient Assistance Active Grant Report and Optum copay card assistance totals report, 2023.
  4. Optum internal analysis based on 18.5 million commercial lives from Jan. 1, 2019 to Sept. 3, 2020.