Clinical Suite

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Clinical Suite

 odular pharmacy employer solutions to help strengthen M health and financial outcomes

Through our unique ability to analyze rich data sets that include both medical and pharmacy claims, we uniquely anticipate health complications and costs that define our comprehensive clinical suite of programs. It’s the backbone of everything we do.

Anticipate Intervene Motivate

Our distinct analytical expertise leads us to effectively intervene with the best clinical programs that enrich your members’ health and care. Our clinical programs significantly reduce costs and improve outcomes.

For members living with chronic diseases, additional comprehensive strategies deliver high-touch service and advanced care management strategies to motivate optimal health while reducing overall health care costs.

Pharmacy care is personal. At its best, it provides much more than the right medication at the right price at the right time. The smartest pharmacy care works well beyond the counter to anticipate complications and costs, then intervenes as needed to help each individual be their healthiest. OptumRx® offers a broad suite of modular clinical solutions that give you intelligent control over your pharmacy strategy, enable us to engage employees and their providers in more effective ways and empower them to achieve optimal health. Because when your employees are healthier, so is your organization.

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Anticipate health complications and costs A disproportionate balance of costs comes from individuals who take several medications, or have multiple diseases. From trend forecasting to formulary design, OptumRx solutions give you intelligent control over which benefits, programs and initiatives best target these individuals — and the rest of your population. Enhanced trend forecasting Dive beyond general data, market events and member information to understand the clinical and financial implications of population-specific and market trends. With OptumRx Trend Forecast, clinical experts parse and analyze the details that will help you plan for the future. Robust clinical intelligence Understand the pharmaceutical landscape and how it will impact your population and bottom line. Clinical pharmacists continually monitor all phases of the drug pipeline to keep you informed on emerging trends and potential cost implications. Powerful formulary management Strengthen decisions, interactions and care by aligning your population’s needs with the right medications. Our formulary management strategy is based on recommendations from the OptumRx Pharmacy and Therapeutics (P&T) Committee of independent doctors and pharmacists, which reviews drugs based on safety, and effectiveness. That’s the power of a well-designed, well-managed formulary coupled with strategic utilization management options. We also maintain transparency by inviting our clients to observe the P&T committee’s deliberations.


Intervene to enrich health and care The better you engage individuals, the better their health outcomes and the lower your health care costs. OptumRx clinical programs encourage appropriate use of medications but also monitor treatment effectiveness by intervening with members when they need it most. That’s smart engagement.


Comprehensive adherence strategy Reduce individuals’ risk for costly complications by helping them continue to adhere to their medication therapy. Using the most current data available and disease-specific monitoring, our adherence programs enable quick intervention by identifying individuals who are at risk of not taking their medications as prescribed. Medication adherence programs

$$ $

3:1 ROI guaranteed1 Safe and appropriate RDUR program 2:1 ROI guaranteed1 Gaps in care RDUR program


return on investment1

Drug utilization review Protect individuals against medication over- or under-utilization, along with drug-drug or drug-disease interactions duplicate therapy, high dosages and gaps in care. Our drug utilization review (DUR) programs can help you understand, interpret, evaluate and improve the prescribing, administration and use of medications. • Concurrent drug utilization review (CDUR) evaluates drug therapy at the point the medication is dispensed. • Retrospective drug utilization review (RDUR) provides a detailed claims analysis using medical and pharmacy claims to identify any issues review of drug therapy after individuals have received their medication. The program also provides ongoing monitoring of drug therapies during the course of individuals’ treatment. We collaborate with prescribers and other care team members to ensure that gaps in care concerns related to behavioral health are addressed and medication therapy is safe and appropriate.

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Proven compound management strategy Keep a close watch on compound medications — those in which two or more drugs are combined to meet the specific needs of an individual. While the U.S. Food and Drug Administration doesn’t oversee these drugs, our compound drug management program monitors their use to ensure that only safe, cost-effective combinations are used. Compound management program results2


Overall drug spend


Compound spend

Timely and personalized medication consultations Optimize drug therapy for high-risk individuals, improve their medication adherence and reduce their risk for adverse events, drug interactions and gaps in care. Our medication therapy management (MTM) program delivers high-touch pharmacist coaching for commercial employers by identifying and evaluating these individuals’ therapy, and then intervenes if needed — before they experience avoidable complications that incur higher costs. Reduction in costs Average commercial book of business MTM annual prescription savings



per intervened member per month


Motivate optimal health


Beyond prescriptions, so many other factors influence individual health. Lifestyle. Setbacks. Health education. OptumRx offers programs and services to help individuals and caregivers understand how all those pieces are connected so they are informed and inspired to make good decisions that lead them to optimal health. Controlled drug management Protect vulnerable individuals and manage health and financial risks by identifying — and even preventing — medication misuse. Our controlled drug management program retrospectively reviews drugs of abuse and also screens for their misuse at the point of sale. We provide intensive case management and coordinate with providers to help guide appropriate behaviors.

Fewer readmissions

71% 30-day readmission rate3

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Hospital transition management Reduce hospital readmission rates and improve care coordination, medication adherence and health care spend. Our hospital transition program focuses on engaging the patient with a pharmacist outreach within 72 hours of discharge notification. The program establishes long-term patient monitoring aimed to pro-actively resolve drug therapy concerns such as adherence to post-discharge medications, gaps in care and drug-drug interactions. Total specialty pharmacy management Control costs while making sure individuals with chronic, often complex specialty conditions have the therapies they need to manage their health. Through our clinical management and specialty pharmacy programs, individuals receive personalized, one-on-one support to help them better manage their condition. BriovaRx, the OptumRx specialty pharmacy, works with payers, patients, prescribers and pharmaceutical manufacturers to help individuals live healthier lives and lower overall health care costs.

Your trusted partner Whether you implement one clinical solution or several, you get a powerful combination of OptumRx expertise, analytics, technology and action — all focused squarely on your health and business objectives. Our solutions can help you: • Design the right pharmacy plan • Identify at-risk members • Offer proven interventions • Proactively engage employees • Improve cost management • Advance care It’s all part of the broader Optum mission to make Healthier happen. We focus on connecting parts of the health care system that don’t always work well together. We use synchronized pharmacy, medical and clinical data to stratify members based on risk. By synchronizing data with our expertise, we can deliver innovative solutions that help make health care better, delivering more cost efficient and effective care.

Learn more Contact your OptumRx representative or email us at [email protected] to learn more about the OptumRx Clinical Suite.


Clinical Suite

About OptumRx OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. Our high-quality, integrated services help deliver optimal member outcomes, smart savings and outstanding customer service. We are an Optum® company — a leading health services and innovation company dedicated to making the health system work better for everyone.

1. ROIs are applicable for clients with >5000 lives who individually purchase the product and are only available for the first year of the program, ROI guarantee is dependent on a prospective analysis. 2. O  ptumRx study April 1–May 31, 2015. Comparing compound-intervened cohort and similarly matched control group. OptumRx and Catamaran are now combined. Some of this information was obtained using Catamaran data. 3. O  ptumRx study of hospital discharge data, August 2013–July 2014. Evaluated readmission data between intervention and control groups to determine same-cause readmission rate at 30, 60 and 90 days. OptumRx and Catamaran are now combined. Some of this information was obtained using Catamaran data.

[email protected] | 2300 Main Street, Irvine, CA 92614 All Optum® trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. © 2016 Optum, Inc. All rights reserved. ORX9528_160601