A pharmacy model for advanced therapeutics

Access to emerging, complex therapies

Rare disease drugs and gene therapies offer new hope for people with debilitating and life-threatening conditions. These drugs also make up the fastest growing segment of the specialty pharmacy market, expected to grow to almost half of specialty drug spend by 2024.^*

Due to an unprecedented level of complexity, these therapies require new levels of service for stakeholders across the health care system.

That's why Optum is expanding its pharmacy care services portfolio and launching Optum^® Frontier Therapies. This new pharmacy business's mission is to support people with compassion while creating access to therapies at the frontier of health care.

An altered, uncertain pharmacy landscape 

The rapid rise of new therapy classes has created a multitude of new challenges. And it's pressuring traditional specialty pharmacies to create innovative solutions. Multiple stakeholders are affected, including:

Patients with a rare disease

Patients often endure years of specialist referrals and testing before being diagnosed with a rare disease. If a treatment is available, accessing it can be complicated. 

These patients and their caregivers need new high-touch care models and support, plus expert management of on-demand manufacturing, drug distribution and the associated high cost of treatment.

Pharmaceutical manufacturers

Manufacturers of orphan drugs and gene therapies often work in limited distribution pharmacy networks and select the partner with specific experience. 

Pharmacy partners must deliver personalized patient care and capture precise data points for long-term patient monitoring. This helps to achieve the best possible outcomes for manufacturers' products and the patients who receive the therapy.

Providers

Many physicians have never prescribed rare disease drugs or gene therapy before. They may be new to the medication requirements, dosing regimens, prior authorization processes, logistical hurdles and high out-of-pocket costs.

They need support to both gain access to these therapies for their patients and manage their patients’ unique needs along the way. 

Payers and plan sponsors

Payers are concerned about these medications’ costs, which can dominate total costs. They need appropriate utilization and management controls, plus reporting, medical and pharmacy care consistency, transparency in data sharing, and a focus on patient outcomes.

Pioneering access for a better tomorrow

Optum Frontier Therapies will work across the drug supply chain to allow smoother, more transparent collaboration between patients and caregivers, pharmaceutical manufacturers, providers, payers and plan sponsors. 

Our deep expertise in pharmacy and patient services combined with leading-edge analytics will help deliver better health outcomes, improve quality of life, and maximize therapy efficacy.

We offer a truly unique suite of end-to-end solutions under one roof. For example, the Optum Frontier Therapies Center for Rare Disease and the Optum Frontier Therapies Center for Gene Therapy offer dedicated teams and focused expertise.

These two teams will tap extensive capabilities — tailored to the needs of a specific therapy or disease state — and provide concierge patient-centric service.

Multiple stakeholders stand to gain value from this new model:

• Patients and caregivers benefit by accessing new, potentially life-transforming treatments along with personalized, disease- and therapy-specific care plans that help remove burdens and set them up for success.
  
• Pharma manufacturers benefit when we distribute and dispense innovative therapies through white-glove logistics, dedicated custom clinical services, and tailored patient and digital engagement strategies, including longitudinal outcome monitoring.
  
• Providers benefit when we partner with them to reduce the ambiguity in managing a new complex therapy and help to ensure that the right patients get access to the therapies that could transform their lives for the better.
  
• Payers and plan sponsors benefit from strong partnership in complex care management. Also valuable is our outcome-tracking support for value-based models that provide patients the access and support they need while helping to reduce the financial risk of emerging therapies.
  

“As more emerging therapies come to market, patients living with rare and devastating conditions are seeing hope of a treatment, or even a cure," said Erin Satterwhite, chief operating officer, Optum Frontier Therapies.

"But with this incredible promise is the reality that the market requires new models to better serve the high levels of complexity in the care pathway.

“Working with pharmaceutical manufacturers, providers, payers and patient advocacy groups, we offer a unique set of services that streamline access to these advanced therapeutics, as well as manage the complex supply chain and follow up with longitudinal monitoring to ensure the best possible outcomes. Optum Frontier Therapies will unlock barriers for patients to access these game-changing therapies and drive better health outcomes overall.”

In summary

Being an independent business allows us greater flexibility to serve the ever-evolving market needs of emerging therapies. But as part of Optum, Optum Frontier Therapies has sound financial backing, plus the combined expertise of OptumHealth, OptumInsight and OptumRx.

We are dedicated to creating access to the therapies that are revolutionizing health care, for all people — no matter how unique. The Optum Frontier Therapies network pharmacy will be available as early as mid-2021.

References

^* EvaluatePharma^® 2020–2024 Orphan Drug Report 2018.