Tuesday, May 02, 2023

Optum Store Opting Out of Direct-to-Consumer Pharmacy Biz

Last November [2022], I blogged (see my post at https://blog.sstrumello.com/2022/11/cigna-express-scripts-by-insiderx.html for reference) how Cigna's Express Scripts was discontinuing the company's cash-pay mail order pharmacy by InsideRx (the coupon website/app is owned by Express Scripts). Well, now rival United Healthcare's OptumRx is doing the same, effectively shutting down its Optum Store. 

Have a look at this notice:

For the moment, the page can also be read online at https://store.optum.com/pharmacy-prescription-update/ but it's unclear how long that page will remain available. I know the image above is impossible to read, but the first paragraph reads:

"We're sad to say that starting June 1st, 2023, you will no longer be able to fill prescriptions through the Optum Store except for on-demand prescriptions, such as Latisse, birth control, erectile dysfunction, and hair loss."

But it looks as if Optum Store is trying to copy what the men's health website hims.com is trying to do, which is sell baldness treatments, erectile dysfunction medicines [boner pills] and similar products and getting out of the mail order pharmacy business more generally. One thing I will point out is to note that the footnote claims: "Optum Store is an affiliate of RVO Health, LLC" which means that today, Optum Store is no longer even owned or operated by United Healthcare Group's PBM business known as OptumRx. Exactly WHEN that occurred is unclear, but evidently, the PBM OptumRx felt it was appropriate to sell the online pharmacy and its OptumPerks coupon-generating website/app business to RVO Health LLC. Incidentally, RVO Health LLC also happens to be the entity which owns Healthline, and Healthline acquired the old DiabetesMine (which was formerly a blog which sold itself to Healthline, which then proceeded to shut it down a few years later). RVO Health LLC evidently now runs Optum Store as well as the OptumPerks coupon-generating website and app. In my view, it's not as if the brand "Optum" is a well-known name which has strong brand recognition because it really does not. Unless you're covered by United Healthcare, you may never have heard of OptumRx.

Now, I could also remind you when, back in August 2022, Optum Store tried to pull a bait-and-switch on the diabetes patient community by claiming it was suddenly making insulin prices affordable for anyone via Optum Store (catch my coverage at https://blog.sstrumello.com/2022/08/uhcs-august-2022-optum-insulin.html for more) when in reality, it was doing nothing other than using Sanofi's ValYou coupons and claiming Optum was somehow helping people with diabetes to afford their insulin. In reality, Optum was responsible for the rebate-driven price inflation in the first place by demanding ever-higher rebates and failing to share the benefit of those discounts with patients. Now it appears, United Healthcare has bailed on the whole direct-to-consumer pharmacy operation completely, not unlike what Cigna's Express Scripts by InsideRx did last fall.

For my part, I knowingly chose to bypass my insurance (which, at the time happened to by Aetna, which is owned by CVS Health which owns/operates the giant PBM Caremark) to buy the generic statin drug rosuvastatin calcium (catch my coverage of that HERE), and I did buy it from Optum Store for a year. Doing so saved me 56% over what Caremark intended to charge me. I hear "Yeah, but it doesn't contribute towards satisfying your deductible" at which point, I tell them "That's only partially true because they only credit you for the PBM-negotiated price, not the artificially-inflated cash price you end up paying." The reality is that Aetna/Caremark planned on charging me $33.84 for 90 rosuvastatin calcium tablets, which worked out to a cost of $0.38/tablet, and yet I got it for $15 instead (or $0.17/tablet), which saved me 56% out-of-pocket. Plus, after calling Caremark, I learned that Aetna would only have credited me about $7.75 for that purchase of 90 generic Crestor tablets anyway, hence it made perfect sense for me to simply bypass my own insurance in this case. In fact, thanks to what the PBM's call "spread pricing" (most typically, on generic drugs), USC researchers investigated and found that nearly one quarter of filled pharmacy prescriptions (23%) involved a patient copayment that exceeded the average reimbursement paid by the insurer (and their PBM) by more than $2.00. In other words, it ends up being cheaper for patients to just pay cash and cut their insurance completely out of the transaction about 23% of the time. (see HERE for more). Then, Optum Store inexplicably raised its price on the generic statin drug by 40% to $21 for 90 tablets (or $0.23/tablet). I had only 1 refill remaining, so I paid the higher price. But I searched elsewhere for the next fill, and ultimately, I said goodbye to Optum Store. Instead, I bought the drug from Mark Cuban Cost Plus Drug Company, and even with shipping added to the price, it saved me even more than I enjoyed by buying it from Optum Store initially. Funny how when every Rx price is fake, you can save so much "money"!

On the upside, we now know that big insulin has grown tired of the PBM commercialization channel eating into their profits and driving list prices through the roof, so they are opting out of the PBM commercialization channel for patent-expired insulin analogues completely (see my coverage on that HERE and HERE), and they have decided to slash prices and cut the PBM's out altogether. No entity deserves that more than the PBM's. As for Optum Store's getting out of the direct-to-consumer pharmacy business, its likely copying what rival Cigna Express Scripts did, along with reading the tea leaves with startups like Mark Cuban Cost Plus Drug Company able to beat them at what they were trying to do, so they're opting out instead.

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