Optum Launches Specialty Fusion to Lower Drug Costs

Pharmacy benefit manager Optum is launching Optum® Specialty Fusion™ today, February 17, a “first-of-its-kind specialty medication management solution,” designed to lower the cost of expensive specialty drugs.

The solution, available immediately to all large health plans, is also meant to simplify care for patients with complex conditions, Optum said in a press release.

“With specialty drug costs projected to reach $505 billion by 2023, health plans and care providers are seeking ways to ensure people get the treatments they need more affordably,” Optum said.

Specialty Fusion provides health care payers and care providers real-time insight into the most effective specialty treatment at the lowest cost to the patient. Results include a simpler experience for providers and faster treatment approvals for patients, while delivering 17% total cost savings in medical and pharmacy spend, according to the PBM.

“The average specialty patient sees more than five care providers per year, while taking more than 10 drugs on average. They often have to wait for multiple treatment regimens to be approved, and need better support navigating their treatment plan and health benefits,” said Kerri Tanner, senior vice president, Optum Rx.

“We developed a new comprehensive, benefit-agnostic solution that supports streamlined treatment decision-making for care providers, helping patients get on their therapies faster, while driving down high costs,” Tanner added.

Using Specialty Fusion, care providers can initiate the approval process for specialty drugs requiring prior authorization using a single portal. Treatment options are then compared against dozens of clinically appropriate, lower-cost options across benefits in seconds, according to Optum.

“Specialty Fusion eliminates the need for a cross-benefit prior authorization process — a burden for providers — and secures treatment approval in real time. This reduces administrative hassle and results in an expected 50% faster access to therapy for patients, while lowering costs,” Optum said.

For example, when a provider prescribes an immunosuppressive drug on the medical benefit, treatment may cost $1,200. Using Specialty Fusion, a provider can see coverage recommendations and select a therapeutically equivalent treatment for $700 less, on average.

Informed by Optum data and insights, Specialty Fusion provides savings options such as preferred products, dosage management policies, best sites of care and additional cost-control levers such as available discounts and pharmacy networks.

"Managing specialty drugs at the earliest possible moment is critical to improving care, clinical outcomes and the patient experience," said Sarah Dye, senior vice president of Optum Health. "Optum Specialty Fusion uniquely partners with the provider to change the status quo of prior authorization, reduce their administrative pain and ultimately help them provide better care for their patients.”