Optum launches program to lower specialty drug costs, streamline care

Optum has officially launched a new program called Specialty Fusion, meant to reduce administrative hassle, manage specialty medication costs and perform best benefit evaluations.

The program will allow providers to use one portal to initiate the approval processes for specialty drugs requiring prior authorizations and see patients' diagnoses, as well as their pharmacy and medical coverage for certain medications, UnitedHealth Group's Optum subsidiary announced Thursday.

"The cost of the drugs, and the fact that they're covered under both the medical benefit and the pharmacy benefit, is part of the web that creates the difficulties in managing these drugs," said Kerri Tanner, senior vice president of OptumRx.

In synchronizing prior authorizations across both of a patient's benefits, they are able to start treatments faster, which is crucial as many specialty patients are polychronic and are already burdened by having to navigate coverage for 10 or more medications and multiple doctors, Tanner said.

From a provider perspective, she said physicians using Fusion can see a patient's treatment options, compared against dozens of other effective, lower-cost options, as well as the best sites of care, pharmacy networks and available discounts for patients across their benefits.

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"Fusion allows (providers) to access a platform that can—in real time—deliver information about a patient's benefits on both their pharmacy benefit and their medical benefit," Tanner said. "(This) allow(s) the physician to select a drug or group of drugs based off of a complete understanding of the patient's medical and pharmacy coverage—and how that coverage can impact the patient's cost and the plan's cost."

Physicians that have interfaced with the system—which is informed by Optum data and insights—have scored the platform high for its ability to save time in securing treatment approval and eliminating the need for a cross-benefit prior authorizations process, Tanner said.

Many health plans and providers are looking to ensure patients have affordable access to necessary treatments, due to the fact that specialty drug costs are projected to reach $505 billion globally by 2023, according to a 2019 IQVIA Institute for Human Data Science report.

An internal analysis by Optum predicts that Specialty Fusion will result in 17% total cost savings on specialty drugs as providers will be able to capitalize on the program's integrated management strategy to conduct a best benefit evaluation at the drug level, lowering both the medical and pharmacy spend.

On average, providers are likely to cut back treatment costs by hundreds of dollars by viewing coverage recommendations and selecting a less expensive, but therapeutically equivalent treatment to prescribe on the medical benefit, the company stated.

"Managing specialty drugs at the earliest possible moment is critical to improving care, clinical outcomes and the patient experience," said Sarah Dye, senior vice president of Optum Health in a news release.