Price Edge compares direct-to-consumer pricing with insurance pricing for generic drugs. It is an optional product being offered to plans.
Optum Rx, UnitedHealth Group’s pharmacy services company, has launched Price Edge, a tool that compares available direct-to-consumer pricing for traditional generic drugs with insurance pricing. Price Edge is an optional product that clients can opt into it. It is being offered to all Optum Rx clients and has been activated for more than 1.5 million Optum Rx members, with an additional 400,000 members being added by March 1.
“When a client opts in with Price Edge, the functionality is automatically integrated within the member’s benefit,” Oron Stenesh, vice president of product and strategy at Optum Rx, told Formulary Watch. “Price Edge will trigger available cash market pricing for covered generic drugs and compare against the insurance benefit price. The lowest price is what the member will pay. All prescription drug transactions using Price Edge are automatically included in the deductible to ensure members get the best price and maximize their benefit.”
Price Edge, however, is not a price match, the company said. Price Edge is powered by Optum Perks, the company’s digital discount card vendor, and scans available cash market pricing, which will typically include common direct-to-consumer pricing platforms. When a client opts in with Price Edge, the functionality is automatically integrated within the member’s benefit. Price Edge will work within any network pharmacy, including Optum Rx pharmacies.
The Price Edge price is then automatically integrated at claim adjudication and triggers if it is lower than the member’s on-benefit cost share. Unlike other cash card market solutions, Price Edge also ensures the transaction counts toward the member’s deductible and out-of-pocket maximum. “It’s important to note that prescription drugs cost less with the Optum Rx pharmacy benefit compared with online cash discount retailer pricing nearly 90% of the time. Price Edge provides added assurance that the member is getting the best price, and value from the benefit, all the time,” Stenesh said.
Optume Rx also offers a tool for providers, PreCheck MyScript, which provides real-time information on a patient’s pharmacy benefits and formulary to help identify the right drug to prescribe and obtain any prior authorizations. Launched in 2017, PreCheck MyScript helps to save provider time and, according to the company, has saved patients an average of $225 and saved plays $415 per prescription.