Optum Rx pharmacy pricing model aims for transparency
The company is promising greater predictability of pharmacy spend to help manage the total lowest net cost.
Photo: Malorny/Getty Images
A new pharmacy model from Optum Rx called Clear Trend Guarantee is seeking to increase transparency around drug costs for members.
The pharmacy services arm of UnitedHealth Group's Optum, Optum Rx is promising that its price-centered offering will offer drug benefit plan sponsors greater predictability of pharmacy spend to help manage the total lowest net cost.
Another model, Cost Made Clear, includes pass-through models that offer cost-plus pricing with lower ingredient costs. Clear Trend Guarantee is an alternative, guarantee-based pricing model that combines retail, home delivery, specialty drug and rebate components into one per-member guarantee.
According to Optum Rx, Clear Trend Guarantee ensures plan sponsors have a clear path to a "bottom line" pharmacy benefits payment to support effective management of drug trend and spending.
This, the company said, will ultimately deliver value to individuals and families who want more predictability.
WHAT'S THE IMPACT?
Company data indicates that current U.S. drug spend is more than $711 billion, up from $493 billion in 2018. It's expected to top $1 trillion in 2028.
Clear Trend Guarantee is a value-based model with shared savings to promote efficient care, said Optum Rx. It also leverages outcome-driven, member- or population-level, disease-specific data to identify more effective care pathways for members.
Beginning January 1, 2025, Optum Rx will offer Clear Trend Guarantee to drug benefit plan sponsors alongside a full suite of Cost Made Clear payment offerings and the traditional and pass-through models currently available.
THE LARGER TREND
Americans pay more for brand-name prescription medications than do residents of most other countries, found a Commonwealth Fund report from January.
Per capita spending on pharmaceuticals is nearly three times the average of other member nations of the Organisation for Economic Co-operation and Development.
The report compared prices of the first 10 drugs chosen for Medicare price negotiations to prices for the same drugs in seven other countries. In all but one case the United States ranked the highest. For six drugs, Switzerland had the second highest price, and Australia usually showed the lowest price.
ON THE RECORD
"It is more important now than ever before to be an innovator in healthcare and to drive affordability and value for plan sponsors and members," said Optum Rx CEO Patrick Conway. "We are not stopping with Clear Trend Guarantee, and will continue to deliver clear information, transparent and lowest net cost, choice and a simplified pharmacy benefit for everyone."
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
