The UnitedHealth Group (UHG) is pushing into the direct-to-consumer healthcare market through cash-only telehealth services that allow individuals to schedule virtual care appointments with medical professionals and get prescriptions for birth control, erectile dysfunction (ED), hair loss, anxiety and depression, and other common medications (e.g., atorvastatin, metformin, omeprazole, etc.).  These services are available through the Optum Store, its online pharmacy which launched in November 2020.  The Optum Store added mental health services in June 2021, including virtual therapy, medication, and other healthcare support.

The Optum Store offers its mental health services on a subscription basis, with monthly fees starting after an introductory cost of $9 for the first month of service.  Subscriptions are month-to-month and can be cancelled at any time:

• $59 monthly fee for medication and support
• $309 monthly fee for therapy
• $359 per month cost for therapy, medication, and support

All services offer unlimited messaging with the Care Team.

Virtual Care appointments are available through the Optum Store at $55 per visit to treat common conditions such as allergies, illness, infection, injury, pain, and skin problems.  Providers will issue an electronic prescription if needed and send it to the patient’s pharmacy of choice.  For patients who need medication treatment for ED and birth control, consultation services are also included as part of the visit.  The initial provider consultation is free for patient and $15 for subsequent consultations.

Optum also provides pricing options for medication treatment for ED and birth control.  Medications that are offered to treat ED are Viagra®, Cialis®, sildenafil, and tadalafil.  The cost of Viagra® is $80 per tablet, while its generic form, sildenafil, starts at $1 per tablet. Cialis® cost $71 per tablet, while the generic form tadalafil begins at $2.50 per tablet.

Optum offers three different methods of birth control: pills, patches, and rings.  Birth control pills or mini pills start at $10 per month when ordering a six-month supply.  The transdermal patch begins at $95 per month, and the ring starts at $68 per month.  Pricing for birth control depends on the patient’s need and days’ supply (90 or 180 days).

The direct-to-consumer healthcare services offered through Optum rival those provided by Hims & Hers, Ro, and Talkspace.

How does this pricing compare for competitors?

Hims & Hers, a direct-to-consumer telehealth company that provides women and men virtual health services, also offers mental health services at $99 per 50-minute session, which differs from other subscription-based services like Optum.  Hims & Hers does not offer text-based therapy, only video therapy sessions.  Pricing for additional services provided through Hims & Hers depends on the individual’s treatment requirements.

Ro does not have a membership fee for services and charges on a per-visit and per-medication basis.   Ro Online treatment services are $15 per visit, not including medication costs.  The total cost of treatment depends on the drug and the amount of medication the individual needs.  Ro offers three different programs:

• Roman is a digital health clinic for men experiencing hair loss, erectile dysfunction, cold sores, and other health needs.
• Rory is a digital health clinic for women offering online reproductive health and beauty services.
• Zero is an online program provided by Ro to help individuals quit smoking using the combination of prescription medication and nicotine replacement therapy. Ro’s Zero program is $15 per visit; the charges for one month of bupropion and nicotine gum are $45 and $42 respectively.

Talkspace is an online and mobile company that offers therapy services to individuals with or without insurance and currently provides three therapy subscriptions options.  Some insurance providers have contracted with Talkspace to cover subscription costs for covered individuals.

• Talkspace Unlimited Messaging Therapy Plus service offers no live sessions, but therapists respond daily, five days per week via text, video, and audio messaging for $260 per month.
• The Unlimited Messaging Therapy Premium plan includes everything the lower-tiered (Plus) program offers with the addition of one 30-minute live session each month for $316 per month.
• The Unlimited Messaging Therapy Ultimate has everything in the previous plans with the addition of four 30-minute live sessions each month for $396 per month.

Will other PBMs enter this competitive space?

Optum’s path to implementation may have been easier due to their association with UnitedHealth Group and the providers under the OptumHealth organization.  However, CVS Caremark’s acquisition of Aetna makes for a seamless connection to providers and would allow for a similar direct-to-consumer model of healthcare services.  CVS has even announced store closures in an effort to focus on primary health services and grow their online pharmacy.  Likewise, the Express Scripts and Cigna merger provides ESI with the same opportunities to establish a direct-to-consumer healthcare service model.  These competing PBMs could take strategic action to offer direct-to-consumer telehealth services.

Impact

Currently, Optum appears to be one of the most competitive in this space in terms of comprehensive service offering and market positioning, which could provide an early adopter advantage.  Optum can leverage its provider network asset to deliver an integrated offering of low-cost healthcare service and prescription dispensing for commonly diagnosed medical needs.  Optum’s venture into direct-to-consumer healthcare could foreshadow the moves of other PBMs in the future.  The ability to pair primary health services to a pharmacy service may prove to be invaluable for PBMs.  It will be interesting to see how future players in direct-to-consumer healthcare affect the pricing of those services.  What impact do you think this addition will have for Optum and on the future growth trajectory of PBMs?

 

Posted January 2022