Optum Study Documents Pivotal Role Specialty Pharmacy Plays in Improving Health Care Outcomes, Lowering Costs

UnitedHealth Group Press Release:

Optum Study Documents Pivotal Role Specialty Pharmacy Plays in Improving Health Care Outcomes, Lowering Costs

• One-year program results in 30 percent lower post-transplant-related medical costs and 13 percent lower overall health care costs

Irvine, Calif. (Jun. 27, 2013) — 

A study published in the Journal of Managed Care Pharmacy measures how clinical management and adherence programs at a specialty pharmacy add value beyond what patients experience acquiring medications at conventional retail pharmacies.

The study, which followed for one year two groups of people enrolled in employer-sponsored benefit plans and who had kidney transplants, found that the specialty pharmacy program group showed consistently lower costs and higher therapy adherence compared with those using retail pharmacies, including a 30 percent reduction in transplant-related medical costs and a 13 percent reduction in overall health care costs. 

"This research should be of great interest to stakeholders in health care who want to improve health outcomes and lower overall costs," said Kevin Host, Pharm.D, senior vice president for Specialty Pharmacy, OptumRx. "It underscores the value of ensuring that patients have a positive experience and receive outstanding support to help ensure adherence."

"We've seen similar outcomes in improving medication adherence and clinical results and lowering medical service costs through our specialty pharmacy programs in oral oncology, rheumatoid arthritis and multiple sclerosis," said Suzanne Tschida, Pharm.D, BCPS, lead author for the study and vice president, Specialty Benefit & Outcomes Strategy, OptumRx. "We have found that, by delivering a simpler, more personalized and convenient member experience, we empower members to manage their medications and take ownership of their conditions."

The study authors noted that medication adherence or compliance – defined as the extent to which patients take their medications as instructed by a physician – is a well-recognized problem in transplant medicine, and concrete solutions are hard to find. Based on available literature on the topic, the study authors found between 20 percent and 70 percent of patients who have received an organ transplant do not adhere to therapy – the rate varying with definitions of adherence measures and study populations. Moreover, the rate of nonadherence is highest at one to three years post-transplant, but it may happen at any point during lifelong therapy.

Study Design 
The study matched one group of 519 people enrolled in an employer-sponsored benefit plan who filled at least 80 percent of their renal transplant immunosuppressant medication prescriptions at the specialty pharmacy in its specialty program, with another group of 519 plan participants who filled at least 80 percent at retail pharmacies.

The study was a one-year retrospective claims analysis after the implementation of a transplant specialty pharmacy program that, in addition to medication dispensing, includes adherence and clinical management programs, member education, and counseling services provided by specialty pharmacists trained in transplant pharmacology.

Primary outcomes included pharmacy medication costs, medical inpatient and outpatient costs and overall health care costs. Patient adherence to transplant medication therapy and health care resource utilization were also evaluated. One-year outcomes post-specialty pharmacy program implementation were compared between the two groups with t-tests for continuous variables and chi-square tests for nominal variables. Results included:

• 13 percent lower total mean cost during the first follow-up year – $24,315 vs. $27,891 (P=0.03)
• 30 percent lower transplant-related medical costs – $5,960 vs. $8,486  (P=0.04)
• More transplant-related prescriptions dispensed – 18.67 vs. 17.90  (P<0.05)
• A higher weighted medication possession ratio – 0.87 vs. 0.83 (P=< 0.001).

About OptumRx
OptumRx is part of Optum, a leading information and technology-enabled health services company dedicated to making the health system work better for everyone. 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®. Visit www.optum.com for more information.

About Optum 
Optum (www.optum.com) is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. Optum comprises three companies – OptumHealth, OptumInsight and OptumRx – representing more than 35,000 employees worldwide who collaborate to deliver integrated, intelligent solutions that work to modernize the health system and improve overall population health.