Pharmacy Managers Unleash Big Data

OptumRx was doing a routine analysis of a client’s prescription-drug claims when it noticed something odd. The company’s spending on acne medicine seemed high compared with those of other customers. Digging into the usage data for clues, the pharmacy arm of the health insurer, UnitedHealth Group, found that employees had been prescribed newer brand-name acne drugs that were, for the most part, combinations of older generic medicines. OptumRx began requiring patients to begin treatment with the cheaper remedies and switch to the pricier ones only if the others proved ineffective. Within six months, the 60,000-employee company had saved more than $70,000, OptumRx says.

Historically, pharmacy benefit managers (PBMs) have been known more for their relentless supply efficiency than their tech chops. But with the easiest savings already in the past, OptumRx and rivals such as CVS Health and Express Scripts have begun mining their huge troves of prescription data in search of economies. “Lowering costs now means having to make really difficult decisions about having to cover one drug vs. another,” says Walid Gellad, who heads the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh. “They’ve had to become more sophisticated in how they make these decisions.”