Point32Health is pleased to announce that we’re collaborating with OptumRx, our pharmacy benefit manager, to introduce the new Orphan Drug Program for 2025.
The program, which will be available as of Jan. 1 for members of our Harvard Pilgrim Health Care fully insured Commercial plans and Tufts Health Direct, offers a targeted strategy based on personalized clinical assessment and support to optimize care and achieve exceptional value for orphan drug therapies.
According to the U.S. Food and Drug Administration’s (FDA’s) Orphan Drug Act, an orphan drug is one that is “intended for the treatment, prevention or diagnosis of a rare disease or condition.” While a rare disease is defined as affecting fewer than 200,000 people in the United States, collectively these conditions affect one in 10 Americans. Since the Orphan Drug Act became law in 1983, more than 650 drugs with an orphan designation have received FDA approval — and orphan drugs are expected to reach more than 20% of total worldwide prescription sales by 2026.
Orphan drugs can cost upwards of $1 million per year, with the average annual cost per member at around $170,000, which is more than four times the mean cost for non-orphan drugs. Orphan drugs may be effective for some people and not others because of differences in response and tolerability. The drugs included in the Orphan Drug Program tend to be difficult to tolerate and feature complicated dosing and significant potential adverse events.
Point32Health and OptumRx’s program will provide ongoing personalized support for members who chronically take one of more than 40 orphan drugs identified as having the greatest opportunity for clinical intervention and cost savings. OptumRx pharmacists who specialize in orphan drugs tailor one-on-one care experiences for members and offer advanced clinical counseling to address their personalized medication needs.
By investing in clinical expertise and careful monitoring of each member’s experience with an orphan drug, we can quickly identify cases of potentially ineffective therapy and work with providers to make informed decisions about next steps.
Point32Health and our vendor partners share an ongoing commitment to working collaboratively with the valued providers in our network. In support of this commitment and as part of our joint Orphan Drug Program, OptumRx pharmacists will engage prescribing physicians to supplement member monitoring and to advise when clinically appropriate therapy changes may be needed.