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Solutions spotlight: Discount cards narrow gaps in care

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A useful component of the pharmacy care services toolbox

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Prescription discount cards were first introduced to the market in the early 2000s. Originally aimed at Medicare beneficiaries struggling with the cost of prescription drugs, discount cards have evolved markedly in recent years. Today, discount cards are an increasingly useful component of the pharmacy care services toolbox.

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As the overall costs of prescription drugs increases1, many plan sponsors are finding more value in discount cards. As broader trends in health care such as high deductible health plans, consumerism and increased patient first-dollar responsibility shift more of the financial burden of care onto the consumer, the demand for discount cards will only increase.

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Pharmacy insight closer look - link to learn more about the history and evolution of discount cards

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Indeed, while 70% of today’s discount card users have insurance, people with high out-of-pocket drug spending represent a small share of enrollees, but a larger share of drug spending2. Beyond offering savings on prescription drugs, some discount cards also include discounts for a broader range of medical supplies, such as diabetes testing supplies.

Our solutions

Given this expanding demand, OptumRx has tailored a variety of discount card offerings to serve the needs of our clients.

Our Enhanced Savings Program is for individuals with existing OptumRx coverage. Free to both the plan and the cardholder, the program is integrated into the existing pharmacy benefit and provides valuable discounts to drugs that would otherwise not be covered. The Enhanced Savings Program provides access to discounts of up to 85% for purchases at our network of over 67,000 retail pharmacies nationwide.

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Because the Enhanced Savings Program is entirely integrated into the existing pharmacy benefit, no physical discount card is issued. Users can simply present their existing ID card at the pharmacy to receive the benefit.

As an integrated program, OptumRx collects all of the utilization data generated from transactions using the card. We can use this data to enhance cost-saving clinical programs and improve medication quality, safety and affordability through a series of point of sale edits. In addition, this data is used for a variety of client reporting purposes.

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For example, while a user of third-party discount card might be able to receive a similar discount for a given drug at the pharmacy counter, the integrated nature of the Enhanced Savings Program could also alert the pharmacist to a potential adverse reaction between the drugs being purchased and an existing prescription the cardholder is taking. This is a key advantage that supports both individual health, while also helping to control overall health care costs.

Closing this data loop enables OptumRx and plan sponsors to work together to become better stewards of a member’s drug utilization. “When it comes to discount cards, it’s not just about helping the member get the best price, it’s about offering the best value,” notes Michael Oshins, National Vice President, Sales and Business Development – Pharmacy Discount Services for OptumRx. “There are all kinds of ways we can help a member if we know they are taking a particular drug.”

The Alliance Savings Program is designed to support individuals and their families who may not have pharmacy benefit coverage under the same plan or have no coverage at all. Accordingly, it’s an attractive option for plan sponsors looking to support constituencies including seasonal and part time workers, and new employees waiting for their coverage to start.

Unlike the Enhanced Savings Program, which is linked to the existing pharmacy card, users of the Alliance Savings Program are issued a new card or can access benefits via a phone app. Moreover, if a plan sponsor meets a minimum employee count, they can “white-label” the card, with custom branding and messaging of their own choosing. “You can put your name on it, use your own message and present it to employees any way you want,” Oshins says.

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Holistic pharmacy benefits

Both the Enhanced Savings Program and Alliance Savings Program afford cardholders new flexibility at the drug counter. From the plan sponsor’s perspective, both programs have numerous advantages:

  • They are fully-supported, turnkey solutions.
  • Plan sponsors can easily leverage OptumRx’s other capabilities to use direct mail and email to interact with cardholders.
  • Plan sponsors also benefit from the scale of OptumRx and its long history of negotiating with pharmaceutical companies and retail pharmacies.
  • As a result, the Enhanced Savings Program and Alliance Savings Program are able to provide point-of-sale discounts that go beyond normal savings seen with discount cards.

Perhaps most importantly, by capturing pharmacy data which would otherwise be lost, the programs can help provide a more complete picture of an individual’s drug usage. This enables better integration with OptumRx clinical programs and helps close potential gaps in care.

According to Oshins, this focus on providing maximum utility for both the sponsor and end user was by design. “We wanted to create a better solution” he says. “These cards provide a whole new level of value to the members that need it."

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References

  1. Optum Trend report Q3 2017
  2. Kaiser Family Foundation. Examining high prescription drug spending for people with employer sponsored health insurance. Oct. 27, 2016. Accessed at:
    https://www.healthsystemtracker.org/brief/examining-high-prescription-drug-spending-for-people-with-employer-sponsored-health-insurance/#item-start
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STATEMENT REGARDING FINANCIAL INFLUENCE:
This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article.