Individuals & Families Employers Brokers Physicians Health & Wellness

UnitedHealthcare Pharmacy

Supporting members with complex conditions.

When it comes to supporting employees with chronic and complex conditions 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.

*Specialty program outcomes based on UHC commercial membership 2007 to 2010. Network contract savings based on 2011 commercial FI membership. Utilization management savings based on a sample of 2011 commercial ASO membership who implemented these programs – Notification, Strategic Benefit Coverage Exclusions, Step Therapy, and Supply Limits. Individual plan results may vary.

Although specialty medications account for only 1% of all prescriptions, they account for up to 36% 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

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 interact with physicians, nurses, pharmacists, lab technicians, and others. We communicate any issues related to her medications such as side effects, adverse reactions, and care plans to her provider. With one-on-one relationships with specialty members, we are better prepared to support Mary.

Monitoring Adherence: During refills, members are screened to make sure they're taking their medication as prescribed. Additionally, we check for lab tests, side effects, and any other complications that may prohibit members from successfully managing their condition.

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 schedule delivery for her refill. This helps Mary adhere to treatment and helps prevent setbacks.

Helping Members Manage Side Effects: During a consult, the nurse believes Mary might have depression and connects her with Optum Behavioral Health Services. We are positioned to quickly contact providers to better support the member and help manage side effects.

Helping Members Live With Their Condition: Mary receives on-going phone calls from a pharmacist or nurse to discuss test results and changes in her condition. She also receives monthly education about her condition, medications, and managing side effects – 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

Specialty Pharmacy Patient Story