Quick Hits: 2019 Optum Forum

Catch up on the pharmacy trends at this year's Optum Forum


Over July 29 and 31st of 2019, leaders from OptumRx and across the industry presented a series of talks on the major transformations happening in the health care industry today. In addition, they gave their insights into the biggest challenges plan sponsors will face within the next 5 years.

Here is a rapid-fire wrap-up of the key moments you may have missed:

OptumRx chief executive officer John Prince kicked off the proceedings with an overview of some key market dynamics. He observed that the PBM Industry was born to solve problems 30 years ago like paper claims. Fast-forward to today, and we are in a completely new world. Our teams deliver pharmacy care services to 250,000 patients each day. These services help empower better choices for members, care providers, and plan sponsors through synchronized care, while driving better outcomes and lower total cost of care.

OptumRx general counsel for policy and regulatory affairs Natalie Pons then presented her perspective on how what’s happening in the regulatory arena will impact affordability and drug pricing.


Drug pricing

Next, OptumRx senior vice president, chief pharma contracting and procurement officer Kent Rogers spoke to consumer affordability and specialty drugs as part of how OptumRx is tackling the biggest challenges in health care. He broke down drug price inflation and costs over the years, especially highlighting specialty drug costs.

Kent discussed the various impacts of competition and patent expirations on prices, and how pharma often protects their patents and limits competition.

Kent gave a high level overview of how different the market is today than 3 years ago and connected those changes to the OptumRx lowest net cost strategy for managing the tremendous cost of the newest therapies. See more from Kent here.


Multiple chronic conditions

OptumRx senior vice president and chief medical officer Sumit Dutta M.D. was next. Dr. Dutta focused on another one of the biggest challenges in health care: Approximately 71% of the total health care spending in the U.S. is associated with people with multiple chronic conditions. He explained what we do differently, like adding clinical value through detailed claims adjudication, and managing complex cases holistically across a range of synchronized Optum services. Watch Dr. Dutta explain synchronized care.


Industry roundtable

An industry roundtable discussion entitled Decoding the Drug Pricing Debate was heavily attended. It was hosted by Debra Barrett, Executive Director, Coalition for Affordable Prescription Drugs, and featured Alex Brill, founder and CEO of Matrix Global Advisors, John Rother, President and CEO, National Coalition on Health Care, as well as Kent Rogers from OptumRx. An opening presentation by Debra Barrett was followed by an interactive panel discussion and open Q&A.

Our panel of experts talked about what it will take to drive a drug price transformation, including legislation and other dynamics that impact the prescription drug supply chain. For more on the state of the industry, you can read this statement from OptumRx chief executive officer John Prince, before the United States Senate Committee on Finance last spring.


Controlling specialty drug costs

As specialty drug costs continue to grow, plan sponsors need specific strategies to help them take control of their costs and improve health outcomes. Wrapping up the session on the 30th, OptumRx senior vice president for specialty pharmacy Michael Zeglinski presented another popular topic: Bend the Specialty Pharmacy Trend: Addressing 5 Key Challenges.

Using client videos, polling questions, and case studies, Mike talked about five of the most important and costly challenges in the specialty world, and highlighted how OptumRx clinical management can make a difference in people’s lives.

Mike explained a key specialty management tool, OptumRx Therapy Solutions, with a real-life patient story: a 14 year old hemophilia patient, his parents, and the client. Therapy Solutions supports patients by helping them understand how to take their specialty medications, and the importance of therapy adherence, among many other services. See more about the OptumRx approach to hemophilia.


Top trends

On the second full day of OptumRx talks (July 31), OptumRx senior vice president and chief analytics officer Andrea Marks joined OptumRx senior vice president and chief pharmacy officer David Calabrese to present a comprehensive review of the pharmacy landscape: What’s Trending in Pharmacy in 2019 and Beyond?

The top trends included:

  1. Consumer affordability and transparency (see more)
  2. Elevating the value of Utilization Management
  3. Advances in pharmacotherapy
  4. Infusing Artificial Intelligence in pharmacy care services (see more)
  5. Pharmacogenomics

In each of these areas, they were provided a summary of key data as well as key strategies that OptumRx is delivering to assist them in managing these trends in a positive way. They also learned about OptumRx’s expanding portfolio of formulary and utilization management tools, and how broader data assets are being incorporated to optimize the value and efficiency of these programs. Lastly, David and Andrea spoke to where OptumRx is making big investments for the future in areas such as precision medicine and pharmacogenomics.


Total Cost of Care

OptumRx senior vice president for product and strategy Dee Grein’s presentation on the “Impact Total Cost of Care: Beyond Drug Cost Management” was timely and well-received.

Clearly, prescription drug costs are just one part of the total cost of health care. In this talk Dee addressed the needs of plan sponsors who are seeking comprehensive management strategies that impact their real bottom line – including both pharmacy and medical costs. She presented the latest OptumRx study outcomes that detail exactly how payers can lower their total cost of care. See the study outcomes here.


Empowering better health choices

OptumRx chief of operations Jon Mahrt hosted a far-ranging discussion of how OptumRx is “Changing the Game on Pharmacy Consumer Engagement,” featuring presentations by Optum vice president of operations Jacob Freshwater and OptumRx senior vice president for consumer marketing Lisa Smith.

Members have to make many care choices throughout their course of treatment. But they can’t always make the best decisions because they don’t have access to the right information at the right time. The audience learned how OptumRx is addressing the critical member intervention points at the doctor’s office, at the pharmacy counter, understanding their benefits and in managing their condition over time.

In particular the presentations focused on how machine learning and AI-powered capabilities like PreCheck MyScript and Next Best Action are revolutionizing the consumer pharmacy experience to guide better health care decisions. The ultimate goal is to help consumers navigate the health system for better health outcomes and more affordable care. See more here.


Don’t miss out

Wait until you see what we have on tap for the 2020 Optum Forum. Check out the Optum Forum 2020 page for more information, including details on the new date and location. 

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This article is directed solely to its intended audience about important developments affectingthe 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.

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