Programs and services to help individuals avoidcostly complications and improve outcomes

A COMPREHENSIVE APPROACH TO MANAGING DIABETES

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Supporting each member with targeted guidance and services. Without careful management, diabetes can quickly lead to cardiovascular disease, kidney damage and a host of other difficult complications. OptumRx® diabetes management helps customers and individuals achieve positive health outcomes and control costs through five core strategies. We also offer enhanced clinical management programs for customers that want to offer additional personalized support.

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T Total diabetes management for total health

Core strategiesC

E Enhanced programs

P The power of Optum

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Personalized support to improve diabetes management

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Preventing complications that drive costs

Only about 55 percent of people with diabetes successfully manage their glucose levels. That means 45 percent are at greater risk for developing cardiovascular disease, nerve damage and other complications that often lead to additional outpatient care, emergency room visits and hospitalization.

OptumRx can help you reduce that risk and keep costs down by providing individuals and their physicians with the guidance and support they need to not only adhere to their therapy but manage total health.

Total diabetes management for total health

successfully manage glucose55% don’t, and are at greater

risk for complications and increased cost of care

45%

3.

These core diabetes management strategies are tailored to help you manage costs and ensure that members have access to effective and cost-effective treatment.

Strategy 1: Concurrent drug utilization review (CDUR)

By reviewing medication utilization during the claims process, we can identify — at the point of sale —whether a medication is safe, cost-effective and clinically appropriate for an individual with diabetes. This helps ensure that members avoid medications that may interact with others drugs, or otherwise be harmful to them based on other conditions they may have.

Strategy 2: Utilization management

We help manage appropriate drug utilization and member safety by:

Requiring prior authorization, step therapy, or quantity limits for specific medications

We have claims edits in place to ensure that prescriptions are adhering to national treatment guidelines on diabetes medications that have demonstrated the best cardiovascular outcomes

We apply utilization management edits and interventions at the point of sale, so pharmacists and members can discuss possible lower-risk, lower-cost medication alternatives from the formulary.

Core strategiesC

4.

Strategy 3: Review medical necessity

Using evidence-based clinical standards of care, we review prescriptions to make sure they are clinically appropriate and to avoid treatments that could be ineffective or cause an adverse reaction.

Strategy 4: Emphasize lower-cost alternatives

The more members have to pay for their medications, the less likely they are to fill their prescriptions or take them as prescribed1. To help remove cost barriers and improve medication adherence, we let members know whenever lower-cost alternatives are available.

Strategy 5: Real-time pharmacy claims audit

• Automated filters and algorithms — We monitor 100 percent of pharmacies and claims and, within seconds,flag those with the highest risk for review.

• Synthethic insulin -specific reporting — We also provide reports on claims for certain fast-acting synthethicinsulins that are — and with significant cost — at the pharmacy.

Core strategies (cont.)

Lower-cost alternative alerts available when members access optumrx.com or call us with a question.

False claims

Identification theft (member or provider)

Document forgeries

The audit process helps

prevent fraud, waste and abuse by identifying:

C

These core diabetes management strategies are tailored to help you manage costs and ensure that members have access to effective and cost-effective treatment.

5.

Billing for one product but dispensing another

Medication adherence program

Medication adherence is critical to managing diabetes and avoiding complications. Our Medication Adherence Program helps members stick to their regimen by letting them and their physicians know when a prescription for diabetes, high cholesterol, or hypertension medication is submitted to a pharmacy, but is never filled, or is late to being filled.

Enhanced programs

Customer case study: Improved adherence

One large customer representing 192,000 lives improved medication adherence using the OptumRx medication Adherence program:2

3.1%higher average

(PDC) among members who received an OptumRx intervention

2.2%more adherent members across the entire customer population

40%higher refill rate

E

These add-on programs offer extra diabetes management support.

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Customer case study: Significant savings

A large commercial managed care organization with more than 500,000 lives reduced costs through all OptumRx RDUR programs.

Medication Therapy Management (MTM), Retrospective Drug Utilization (RDUR), RDUR Safety, and RDUR Review Gaps in Care

Our MTM program, combined with our RDUR Gaps in Care program, provides personalized support to help individuals better manage their diabetes, improve health outcomes and reduce costs:

• Medication Therapy Management program — By evaluating medication therapies, we can identify and shareopportunities to improve adherence, reduce risk for drug-drug interactions, and participate in appropriate clinicalprograms. Each member receives a personalized pharmacist consultation to review diabetes-related action items suchas glucose management and wellness exams.

• RDUR Safety & Gaps in care programs — We review past pharmacy and medical claims to identify memberswhose therapies may be unsafe or inappropriate. We then work with the member and physician to start a moreclinically appropriate therapy. Common causes include:

— Drug-drug interactions

— Member age or condition

— Duplicate medications

— Overuse

— A high dose

Enhanced programs (cont.)

12 months of claims evaluated to compare outcomes between program-enrolled group and control group

78,000 MTM- and RDUR-eligible members’ medical and pharmacy claims analyzed

$34.66 saved per treated member per month compared to control group3

E

These add-on programs offer extra diabetes management support.

— Gaps in therapy/care

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Optum® solutions surround members with proactive support

We are part of Optum, a leading health services company that helps make the health system work better for everyone. And with the power of Optum data, analytics, technology and expertise, we also offer add-on programs for even more targeted diabetes management support.

• Programs for high-risk members — Drive member engagementby allowing them to view, track and share their biometric datathrough our integrated health and wellness website. Optumnurses and health coaches can view the latest biometric numbersand create an action plan tailored to the individual.

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The power of Optum

Care reminders: Proven results

Members who receive reminders are:

more likely to resolve a disease-monitoring issue49%more likely to resolve a potential medication adherence issue30%

Care reminders— Help individuals and their physicians manage health proactively to avoid complications by sending HealtheNotes and HealtheNote Reminders. We monitor 100 percent of yourpopulation, providing personalized communications that deliver measurable results.

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Additional solutions surround members with proactive support

• Biometric solutions — Provide biometric screening for your entire population to better understand health risks and inspire individuals to take action based on expert support and guidance.

• Wellness coaching — Reduce health risks and help prevent additional chronic diseases withone-on-one wellness coaching by phone, in-person consultations and by mobile device. Our wellness coaches have helped more than 50 percent of participants achieve their program goal, whether it was managing a chronic condition, preventing one, or maintaining a healthy lifestyle.

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Connected Condition Management

The power of Optum

Proven results

Customers have saved $0.90–$2.69 PMPM through OptumRx Connected Condition Management.4

We offer performance guarantees for customer satisfaction, clinical evidence-based measures, and financial results.

* This solution requires medical claims and is available for customers with 10,000 or more lives.

Connected Condition Management is an integrated solution that connects medical, pharmacy and lab data to identify health risks and clinical opportunities — beyond pharmacy — for people with diabetes and other chronic conditions. Connected Condition Management leverages many different Optum company assets to drive improved outcomes.*

Members are stratified using our treatment algorithms, and segmented based on risk: high, moderate and low. Next, we target specific kinds of interventions that are associated with each members risk profile.

For example, high risk members are highlighted for enrollment in disease management programs, which includes a dedicated nurse for follow-up. These Optum nurses answer questions and help at-risk members learn how to better manage their condition, symptoms and medication.

And because lab results are part of the 360-degree view, pharmacists and physicians can monitor glucose levels and medication adherence. The goal of this holistic focus on total health to improve outcomes and reduce overall costs.

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(cont.)

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2. OptumRx customer analysis. 2016. Benchmark outcomes are not a guarantee of future results.

3. OptumRx customer claims analysis. 2016. Outcomes are not a guarantee of future results.

4. OptumRx book of business. 2016. Outcomes vary by customer and are not a guarantee of future results.

5. Patient Preference and Adherence. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Published online July 22, 2016.

See how we can helpOptumRx is a full-service pharmacy care services company serving more than 65 million members with innovative prescription drug benefits services. Our resource library is full of great ideas and examples of how we are helping clients achieve better health outcomes and lower overall costs.

OptumRx is part of Optum®, a leading information and technology-enabled health services business dedicated to making the health system work better for everyone.

Statement regarding financial influenceThis article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article.