Optum Rx is rolling out a slate of new programs that seek to support independent pharmacies in managing costs and more complex patient needs.
The first offering under this initiative is Optum's new Independent Pharmacy Network, which is available as an add-on for its pharmacy benefit management clients. In contracts that select this option, independent and community pharmacies will receive 5% higher reimbursements for generics and 0.2% higher for branded drugs.
The PBM said this program follows other changes enacted to support independent pharmacies; for instance, it does not collect direct and indirect remuneration, or DIR, fees and removed clawbacks for independent facilities.
Katie McCarey, vice president of pharmacy strategy and product innovation at Optum Rx, told Fierce Healthcare that these pharmacies play a critical role in communities, particularly those that are underserved, and have earned trust from patients.
"A lot of our members have that really great one-on-one connection with that independent pharmacist and have been visiting that pharmacist for many, many years," McCarey said.
Beyond the option to enhance reimbursements for these providers, Optum is establishing and enhancing multiple programs that are designed to enable them in managing patients' social needs. Given that many patients may struggle with access to care overall, local pharmacists can pay a role in filling the gaps where provider options are limited, according to the company.
Optum's initial Bridge program, called Bridge to Healthy Baby, provides pregnant women who maintain prescriptions for prenatal vitamins with care kits that include key items for managing pregnancy and for caring for a baby after birth.
The PBM will donate $25,000 to diaper banks in five new markets as it grows the program.
Alongside growing the Bridge to Healthy Baby program, Optum has rolled out the Bridge to Pharmacy Care and Bridge to Wellness Program offerings to independent pharmacies, too. Bridge to Pharmacy Care assists members with transportation to and from the pharmacy, and reimburses pharmacists for connecting patients to these services.
Through the Bridge to Wellness Program, meanwhile, Optum Rx aims to support pharmacists in managing the cost, utilization and clinical complexities associated with chronic conditions, including diabetes. Under this program, patients can be assessed on their current health, monitor their A1c, have a foot exam and support for their medication regimen.
Pharmacists will be reimbursed for these services, Optum said.
McCarey said this initiative in particular was designed to lean into the trusted relationship patients have with their local pharmacists.
"The pharmacist really helped with the adherence of those medications," she said.
Next year, Optum intends to roll out Bridge to Provider Care, which will connect members living in care deserts with telemedicine at no cost. McCarey said that the pharmacists can connect patients with a primary care provider virtually while they are at the pharmacy.
"As soon as these independent pharmacists assist us with these programs for every single member or patient, they actually are incentivized," she said. "So that also is a great benefit to the independent pharmacy."