UnitedHealthcare pitches integrated benefits, pharmacy savings and five-day behavioral-health access in Hillsborough County RFP review

HILLSBOROUGH COUNTY — UnitedHealthcare and its OptumRx division presented their proposal on behalf of UnitedHealth Group on Oct. 12 during the evaluation committee meeting for RFP 24-24912, the county’s request for proposals for a self‑funded group health plan administered for the Human Resources Department.

The vendor told the committee it offers a Choice Plus provider network that it said covers roughly 98–99% of the county’s current providers, an expanded behavioral‑health network with an "Express Access" option that guarantees an initial appointment within five days, and pharmacy integration tools intended to reduce specialty drug costs and increase generic dispensing. UnitedHealthcare also proposed a one‑time credit of $700,000 in year one and $175,000 annually afterward, and said it met a 13.5% MWBE spend target included in the RFP.

Committee members heard specifics on financial and operational items that matter to a self‑funded employer: UnitedHealthcare said its administration would run on an ASO model with no capitated behavioral‑health or radiology charges included in its claims reporting. OptumRx described pharmacy interventions intended to reduce net pharmacy spend, including moving certain brand prescriptions to generics and using biosimilar substitutes where appropriate. The firm also described its Surest program, a variable‑copay approach that steers members to providers the company ranks as delivering the best outcomes.

During the presentation, Aaron Carper, vice president of public sector sales for UnitedHealthcare State Florida, said, “I can promise you that if we earn your business, we will take care of your employees.” Jeff Stoeffer, vice president of sales for OptumRx, summarized the vendor’s position on pharmacy transparency and compliance: “We are following all of the Senate Bill 1550 guidelines,” referring to recently enacted transparency requirements the team said apply to pharmacy benefit management.

OptumRx offered three specific pharmacy points to the committee: (1) integration of medical and pharmacy data can reveal savings opportunities; (2) specialty drugs are a principal driver of pharmacy spend (the presentation noted specialty accounted for about 52% of the plan’s pharmacy dollars in the sample data the vendor reviewed); and (3) targeted formulary design and distribution changes can yield meaningful savings with limited member disruption. Stoeffer said the vendor’s review of the county’s data suggested current pharmacy costs were about $10 per member per month (PMPM) and that some interventions could move groups toward savings as large as $26 PMPM in specific cases, depending on plan choices and member impacts.

On behavioral health, the presenters said their expanded network in Hillsborough County includes nearly 3,000 behavioral‑health providers and that an Express Access pathway can produce an intake appointment within five days of outreach. Benson Porter, vice president of sales and account management in Tampa, told the committee the Express Access capability responds to post‑COVID demand for faster behavioral‑health access.

Committee members asked whether the small percentage of providers not matched in the vendor’s network included specialists that could produce access problems; the vendor said it would run a disruption analysis and, if necessary, recruit missing providers to the network. The committee also asked about how biosimilars and step therapy would be handled; OptumRx said existing members on Humira could remain on that drug, while new starts would be steered to a biosimilar (referred to in the presentation as “AmgenVita”); the vendor also described an exception and peer‑review pathway for members who need to return to originator biologics.

The presentation covered operations and implementation details the committee flagged as important: on‑site customer service representatives, wellness staff and a field account manager role were included in the vendor’s proposal; the vendor said those staff would be funded by the proposal and that it would engage with any currently on‑site vendor personnel during implementation discussions. UnitedHealthcare said the county could elect whether the county’s employee medical center services would be billed as claims or set as a fixed cost, and that prior‑authorization rules and other administrative settings are configurable during implementation.

The vendor addressed public reporting and a circulating figure about claim denials. A presenter said there was misinformation online claiming a 32% denial rate; the presenter said commercial denial rates are generally below 10% and “really it’s between 5 [and] 7%,” and that the vendor would pull client‑level numbers for the county to provide accuracy.

Committee members also asked about the timing and cadence of pharmacy‑performance reviews; OptumRx recommended an initial post‑implementation period before producing mature analysis, then quarterly or semiannual reporting thereafter and ad hoc reviews for large claims. The vendor confirmed rebate and discount guarantees would be detailed in proposal spreadsheets and are part of the evaluation work the committee and consultants will complete.

No formal committee decision or vote was recorded at the meeting; the session was a vendor presentation and question‑and‑answer period limited to committee members and technical advisors.

Looking ahead, the committee's next steps include receiving disruption analyses and clarified implementation details from the vendor team, and continuing evaluation of proposals from other firms responding to RFP 24‑24912.