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OptumRx

Published Online: Monday, October 14, 2013
With More than 20 Years of Experience, OptumRx Is One of the Largest US Pharmacy Benefit Managers

OptumRx is an innovative pharmacy benefit management business managing the prescription drug benefits of commercial, Medicare, and other governmental health plans, as well as those of employers and unions, through a national network of 66,000 community pharmacies and state-of-the-art mail-service pharmacies in California and Kansas, both of which have earned the prestigious Verified Internet Pharmacy Practice Sites™ (VIPPS) accreditation by the National Association of Boards of Pharmacy.

OptumRx is part of Optum, a UnitedHealth Group company and a leading provider of integrated health services dedicated to making the health system work better for everyone. The strong synergies between these companies enable us to deliver smarter, more cost-effective medical, pharmacy, and health and wellness solutions.

From pharmacy-only services to fully synchronized options that include medical, disease management, and pharmacy, we work with our clients to design the most clinically appropriate cost-minimization strategy.

We have all the resources and capabilities of a large pharmacy benefit manager, with the flexibility and personalized service that clients need. They benefit from our operational expertise, unparalleled service, an industry-leading emphasis on maximizing generic drug usage, and a deep understanding of how to customize and cost-effectively manage pharmacy benefits.

OptumRx Specialty Pharmacy
Our competitive advantage is our ability to manage specialty pharmacy across both medical and pharmacy benefits. Our specialized teams, distribution channels, training, and outcomes make a measurable impact on the lives of our customers. Utilizing a nontraditional approach, we have achieved:
  • Significantly lower gaps in therapy
  • Higher adherence (16% to 53%)
  • A savings of around $5 per employee per month in a typical 10,000-life group
Through our experience and multifaceted approach, we have the unique ability to comprehensively manage a specialty pharmacy strategy that is best aligned with our clients’ objectives.

OptumRx Clinical Programs
Delivering quality health care is our top priority. Our clinical programs and services address care components across more than 200 disease states and conditions.

We can synchronize medical, pharmacy, and clinical data in a unique way that supports member health awareness and behavior. This enables us to apply the full breadth of our resources to managing costs by achieving healthier outcomes.
Generic medications provide excellent value and quality for consumers and payers. Our generic utilization rates are among the best in the industry, at more than 80%.

Innovative Tools and Strategies
OptumRx excels at developing innovative and integrated health service tools and strategies to manage pharmacy cost trends. These include our Value Pharmacy Network and OptumRx Value Optimizer Prescription Drug List.

ProtectRx™ Aggregate Stop Loss insurance provides solid protection against rising and unpredictable pharmacy benefit costs. It caps client liability for total pharmacy benefit costs for a full policy year.

By filtering 100% of claims through our proprietary Real-time Audit System, we reduce errors, often before payment. This improves quality and reduces the cost and time required to recover dollars after they have been paid out for fraudulent or erroneous claims.
Our online Prior Authorization (PA) service streamlines submission, review, and approval of PA requests, providing physicians with real-time responses in most instances.

Steady Growth and Financial Performance
OptumRx is growing steadily. Our revenues increased over 60% in the last 5 years, while our membership has more than doubled.

As part of Optum, we serve 250,000 health professionals and physician practices, 6200 hospitals and facilities, more than 270 state and federal government agencies, over 2000 health plans (including 40% of the Fortune 500), 400 global life sciences companies, and 1 in 5 US consumers. «

For more information, see OptumRx's directory listing or visit www.optum.com.


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