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Specialty Pharma Solutions for Health Plans

Manage specialty medical drug expenses.

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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 includes1:

  • 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:

  • Over 14 million data points collected with more than 1 million data points for clinical guidance1

Optum expertise:

  • Over 29 million lives managed through the program1

Proven outcomes:

  • Average provider Net Promoter Score®: 621
  • 75% of requests entered by provider through SGP website1
  • Over 91% preferred product adoption1
  • Over 80% site of care adoption1

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

The projected specialty medicine spend by 20232 is $505 billion.

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High cost

The average cost of a specialty drug will be $84,000–$136,000 in 2023.3

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Increasing number of specialty drugs

The per member annual specialty spend is projected to reach $1,276 in 2023.4

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Additional insight

Medical knowledge doubles every 73 days.4

What is SGP?

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Additional resources

White paper

Learn what’s new with the Specialty Guidance Program (SGP).

White paper

We're keeping up with the ever-changing specialty drug market.

White paper

Learn 5 things payers need to know about the looming biosimilars boom.

Sources

  1. Optum book of business proprietary analysis. Results will vary by client.
  2. EvaluatePharma. Orphan Drug Report 2019. April 25, 2019. Accessed January 2023.
  3. PR Newswire. Global $568 billion specialty pharmaceuticals market to 2026: leverage the changing face of specialty pharmacy industry with flat world solutions. September 10, 2019. Accessed January 2023.