Suzanne Tschida, PharmD, Discusses Benefit Design in Specialty Pharmacy Management

Suzanne Tschida, PharmD, vice president, specialty benefits & outcomes, OptumRx, said that at UnitedHealth Group a tiering system is used for the management of specialty medications with a cost-share or copay structure. Since specialty medications tend to have a higher cost-share, Dr Tschida said utilization programs are put in place to help patients stay adherent. ”That’s where we take the approach of appropriate benefit design along with making sure they have appropriate formulary strategies and utilization management programs in place to incent the member to be adherent to their therapy,” said Tschida. Prior authorization, step therapy tiering, and other utilization management programs are all important tools in improving specialty medication adherence as well as lowering costs.