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UnitedHealthcare Pharmacy

Supporting members with complex diseases.

When it comes to supporting employees with chronic and complex diseases such as hemophilia, HIV, MS and oncology, having the right specialty pharmacy program is critical. These life threatening and debilitating diseases take a heavy toll on the entire family and require frequent, ongoing clinical support.

*Average savings across eight specialty conditions for combined medical and pharmacy costs based on UnitedHealthcare commercial membership in 2008. This potential savings amount is not guaranteed. Applies to self-funded customers only. Actual savings may vary.

Although specialty medications account for only 1% of all prescriptions, they account for up to 34% of costs under the pharmacy benefit.

In spite of the high cost of specialty drugs, it is important to focus on the patient and the condition and not solely on drug management.

Our total care management approach can help members become more engaged, which can lead to increased adherence and better health decisions – which can result in better health and lower costs.

Total Care Management

Mary's story – breast cancer

Our total health approach goes far beyond medication management. We support members by coordinating among physicians, pharmacists and OptumHealth nurses to keep individuals on track with the most appropriate drug and care regimen.

Watch Mary's story

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Drug management »
Coordinating with physicians »
Monitoring
compliance »
Continual member outreach »
Helping members manage side effects »
Helping members live with disease »

Drug Management: Our approach starts with drug management. To make sure Mary's oncology medication is affordable, Mary's doctor prescribes an affordable Tier 2 oncology drug. We aggressively manage drug pricing – and review utilization and distribution so that members get the right drug at the right price at the right time.

Coordinating with Physicians: Through the course of her treatment, Mary will need to communicate with physicians, nurses, pharmacists, lab technicians, and others. We help by coordinating communication among the providers. With visibility to lab and clinical data, we are better prepared to support Mary and all of her health care providers.

Monitoring Compliance: We constantly review claims data for for gaps in drug adherence, and identify missed physician visits and lab work – this enables us to intervene, if necessary, and reduces the risk of medical emergencies.

Continual Member Outreach: Every day Mary receives a text message to remind her when it's time to take her medication. We also support her with a phone call every month to remind her to refill her prescription. This helps Mary adhere to treatment and helps prevent setbacks.

Helping Members Manage Side Effects: Our visibility to lab, pharmacy and medical data enables us to review for complications or potential interactions. During a consult, the nurse believes Mary might have depression and connects her with OptumHealth Behavioral Solutions. We are positioned to quickly reach out to physicians to better support the member and help manage side effects.

Helping Members Live With Disease: Mary receives on-going phone calls from a nurse to discuss test results and changes in her condition. She also receives monthly education about nutrition, managing side effects, and traveling with her medication – all designed to help Mary live healthier.

Medical Specialty

Managing specialty medications under both pharmacy and medical benefits helps contain the total cost of care while improving the quality of life for employees living with complex diseases.

Watch This!

The UnitedHealthcare Specialty Pharmacy Program

Specialty Pharmacy Member Experience