UnitedHealth’s OptumRx Seeks Refunds When Expensive Drugs Fail

As UnitedHealth Group Inc. bulks up, it’s negotiating tougher terms with drugmakers to rein in costs, pushing for refunds when medications don’t work for patients.

UnitedHealth’s pharmacy-benefits business, OptumRx, completed its acquisition of rival Catamaran Corp. Thursday, giving it increased scale in talks with pharmaceutical and biotech companies.

Mark Thierer, who now runs the combined firm after leading Catamaran, said OptumRx has already worked out a deal with Gilead Sciences Inc. to tie payments to the performance of the drugmaker’s hepatitis C treatments. The medication for the liver disease can cost more than $1,000 a pill before discounts.

In a clinical trial, Gilead’s drug Harvoni cured 96 percent of patients with the most common form of hepatitis C and no scarring of the liver. Gilead didn’t immediately respond to a request for comment.

OptumRx is negotiating similar performance-based deals with makers of drugs for high cholesterol -- known as PCSK9 inhibitors -- and medications for multiple sclerosis treatments and rheumatoid arthritis medicines, Thierer said.

“We’re actively engaged in discussions that would effectively contemplate having the innovator companies make some level of assurances around, ‘Will this drug work?’” he said by phone. “We’re going to have the innovator companies stand behind the science of the drugs they’re bringing to market.”

Measurable Outcomes

Payments or refunds would be tied to measurable outcomes, though it’s too soon to say what measures might be used in the case of PCSK9 inhibitors, he said. The drugs, made by Amgen Inc., Regeneron Pharmaceuticals Inc. and Sanofi, are expected to be approved in the coming weeks in the U.S. They’re designed to help patients with very high levels of bad cholesterol who can’t control the condition with statins.

Pharmacy-benefits managers like OptumRx and rivals Express Scripts Holding Co. and CVS Health Corp. have been working to push down the prices of high-cost drugs. For hepatitis C, they’ve demanded hefty discounts in exchange for exclusively carrying a treatment from either Gilead or AbbVie Inc.

Spending on drugs for conditions like cancer and hepatitis C fueled a 13 percent jump in per-person drug spending by commercial health plans last year, Express Scripts said in March. Specialty drugs made up about 1 percent of prescriptions last year, and accounted for about a third of spending.

OptumRx is the third-largest drug-benefit manager, with about 65 million clients, according to Bloomberg Intelligence. Express Scripts serves 90 million people and CVS has 71 million customers. The top three firms control about 80 percent of the market.

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