Pharmacy Benefit Managers (PBMs) have always worked to help lower the cost of prescription drugs for members. However, these efforts have not always been readily apparent to the person picking up a prescription at the pharmacy counter.
This is changing. As part of a broader effort to improve and simplify pharmacy benefits, OptumRx is acting to share discounts funded by drug manufacturer rebates. These discounts will be applied directly to members when they fill prescriptions through retail pharmacies, specialty pharmacy or home delivery.
Rebates are a commonly-used tool for PBMs, but they can be misunderstood. Traditionally, the rebates negotiated with pharmaceutical companies were used collectively, to keep premiums lower for all clients and their members.
In contrast, the goal of point of sale (POS) discounts is to use a portion of the rebate to deliver lower out-of-pocket costs directly to eligible members, and help make prescriptions more affordable at the pharmacy counter.
We recently announced that discounts at the point of sale will apply to over seven million people enrolled in UnitedHealthcare fully insured commercial group benefit plans, beginning on Jan. 1, 2019. At the same time, UnitedHealthcare self-funded clients will have this option available to them if they determine it is the right benefit strategy for their organization. The stand-alone solution is currently available to OptumRx clients who do not receive their pharmacy benefits through UnitedHealthcare.
Here’s how the discounts work. When a member presents a prescription to the pharmacy, or places an order for home delivery, OptumRx systems will identify if that drug is eligible for any discount. If the drug is eligible, the discount will be automatically applied to their medication cost at the point of sale, resulting in lower out-of-pocket costs. Before presenting a prescription, plan participants can also log-in to their benefit website or mobile app to see how the discounts will impact their cost-share amount.
By delivering savings directly, discounts at the point of sale provide a better member experience. They also build on a legacy of innovative OptumRx products and services -- all designed to simplify pharmacy benefits for members, doctors, pharmacists and payers.
For example, the recently launched PreCheck MyScript tool brings new levels of visibility to the prescription process. PreCheck MyScript is an innovative suite of tools designed to fit comfortably within a physician’s existing workflow. It provides drug-specific, benefit-specific, and clinical program data for individual members at the point of prescribing. This way, doctors can see how much their patient would have to pay for a medication if they went to their preferred pharmacy at that very moment to pick it up. PreCheck MyScript also enables doctors to suggest lower-cost alternatives for higher-cost medications in order to lower out-of-pocket costs.
Taken together, these initiatives represent some of the steps OptumRx is taking to provide greater convenience and cost savings to members filling prescriptions and enhance the value of pharmacy benefits.
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.