In these strange times of social distancing due to COVID-19, a pharmacist’s call to review prescription medications may be the only human contact a person experiences on a given day. For others, concerns about how to refill a prescription may be weighing heavily on their minds.
A sense of readiness and responsibility is driving Dr. Sumit Dutta, senior vice president and chief medical officer of OptumRx, and his team to help. They are working not only to make sure medications are available but also to provide comfort.
“All of that time going to medical school, all of that time practicing, treating patients, all of that time building a team of talented professionals, all of that work, is really about this moment — the moment that we’re able to help our 56 million members, all of them going through the same thing together,” says Dr. Dutta.
Dr. Dutta and his team are moving quickly to find ways to address challenges like access to medication, anxiety and isolation.
Adjusting pharmacy policies
Already they’ve adjusted a number of pharmacy benefit policies in response to the quickly evolving regulatory landscape, including those regulating how often members can fill a prescription and the amount they are allowed in one refill.
“We immediately lifted restrictions so that OptumRx members would be able to get an extra supply of their medication and have that on hand during this time when it may be difficult to get to the pharmacy,” says Dr. Dutta.
One of those restrictions is the “refill too soon” policy, which requires a certain number of days between refills. Since it’s been suspended, members can get a one-time refill early. Another change allows specialty pharmacy patients to fill a one-time 90-day supply of key chronic specialty medications, versus the traditional 30-day supply.
Similarly, some rules requiring providers to get approval from a health plan before prescribing a medication are being relaxed. That way, patients won’t need to wait or go into a physician’s office. It should also reduce paperwork for providers.
Patients in need of infusion services like chemotherapy and cancer immunotherapy can benefit from home infusions.
Patients can also obtain brand-name versions of in-demand medications like albuterol, a common asthma inhaler medication, when generics are in short supply. If there’s a risk for shortages of other types of drugs, OptumRx will know and be ready to respond.
“By monitoring the supply chain and using data analysis to note spikes in demand, we can determine if we need to expand operations or make a policy change,” says Dr. Dutta.
Easing anxiety: Connecting through conversation
With changes and concerns come questions. In March, OptumRx call volume was up 20%. OptumRx customer service representatives picking up member calls provided answers on the first call.
“The goal is to address the anxiety that people have by providing good information,” says Dr. Dutta.
He says his team is using data to learn about callers’ needs. They know calls in which COVID-19 is mentioned are longer than other calls — a detail that can help determine staffing levels required to meet members’ needs.
Pharmacy staff is not always waiting for people to call. In some cases, they are proactively reaching out to members. For example, OptumRx is reaching out to their highest-risk Medicare members to educate members about the ability to use home delivery, if they don’t want to put themselves at risk by going to a pharmacy.
Providing comfort: Addressing social isolation
“We knew that there would be a number of seniors who would be isolated in order to stay safe. They’re really at increased risk for some of the more severe complications of this disease,” says Dr. Dutta. “We ensured that OptumRx representatives who would be reaching out to those members would have the opportunity to comfort them and guide them during this unprecedented time.”
The conversations are designed to understand the member’s health needs, check for adverse medication interactions and discuss how to stay safe and healthy during this time.
“These are important interactions and sometimes the only touch points these patients are having that day,” says Dr. Dutta.
He says, besides offering comfort, the conversations can help identify new challenges facing members. His team is listening carefully.
“We’re addressing issues as they come up, because they’re all new. There’s no history for dealing with this. Certainly, there are things that we’ve addressed in the past like hurricanes and wildfires that we can draw on in developing solutions. But there is clearly something that is different about this — its magnitude. We will continue to find ways to connect with members and make their lives easier. We are ready to make a difference.”