Specialty Pharmacy Management for health plan partners

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Prescription drug spend in the U.S. is high and continues to rise. Specialty drugs now account for nearly half of that spending.

Infused specialty drugs are a key cost driver with 14% year over year increases. Infusion therapy is delivered in a variety of locations; hospital, physician’s office, infusion suite, or home… where therapy is delivered impacts both the member's care and the total treatment cost. For example, look at the infusion therapy costs for multiple sclerosis. Hospital treatment is nearly twice as expensive, and typically less convenient, than care delivered in the physician’s office or patient’s home.

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That price difference creates an opportunity to guide patients to a more cost-effective and convenient site of care for their treatment. The Optum Specialty Redirection Program does just that! For example meet “Mark” our patient. His physician sends him to the hospital to get an infusion for treatment of Crohn’s disease. With round trip hospital travel, Mark is forced to take time away from work, and the cost to the Plan sponsor is $10,000 per infusion. With the Specialty Redirection Program, Optum works with the Plan Sponsor to determine if Mark meets the criteria for a more cost-effective site of care. If so, the Optum Specialty Redirection “patient navigator” works with Mark and his provider to select the most clinically appropriate and convenient location.

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Mark chooses a nearby infusion suite, saving him time away from work, with a lower cost to the Plan sponsor of $6,000 per infusion.

The year-end differences: Mark misses no time at work, likes the infusion suite’s comfort and flexibility, and the Plan sponsor saves $48,000 per year. Many patients would prefer to receive their infusion at home, or at an infusion suite close to home - but aren’t aware of the option. Optum works closely with the patient, their physicians, and the infusion partner to ensure a seamless process. Implementation is quick and easy and can save a plan sponsor over $15 Per Member Per Year. Ask us how we can help you seamlessly implement the Specialty Redirection program today!

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