All consumers are entitled by law to receive an annual copy of their medical report file kept by OPTUMInsight, Inc., formerly Ingenix, Inc. (a division of OPTUM, Inc., which is a wholly-owned subsidiary of UnitedHealth Group, Inc.) Under an order from the Federal Trade Commission in 2008, OPTUMInsight, Inc. (formerly Ingenix, Inc.), and all healthcare and insurance companies that utilize the MedPoint prescription profiling technology, agreed to abide by the Fair Credit Reporting Act.
OPTUMInsight, Inc. was formerly known as Ingenix, Inc. until the company was recently acquired by OPTUM, Inc., a wholly-owned subsidiary of UnitedHealth Group, Inc. Now, OPTUMInsight, Inc. sells the MedPoint prescription profiling data product. Consumers should be aware that OPTUMInsight, Inc. has contractual relationships to acquire data from Pharmacy Benefit Managers (“PBM”), which maintain records of individuals’ prescription drug histories. OPTUMInsight, Inc., through MedPoint, obtains an insurance applicant’s five-year prescription drug history from the PBMs and creates a prescription medical profile on the applicant for the insurance company.
The MedPoint Prescription Report generated by MedPoint includes, but is not limited to, prescription drugs, including dosage and number of refills filled by the insurance applicant for the previous five years. It also includes for each drug, the name and address of the dispensing pharmacy, as well as the name and address of the prescribing doctor, including specialty medical practice. The medical profile generated by MedPoint analyzes the individual’s prescription drug history, and provides, based on that analysis, potential medical conditions that may be present and predictive scores for the individual. (Source, Federal Trade Commission Complaint, February 2008).
How does the MedPoint prescription profiling technology work? When an insurer makes an online query about an applicant, the MedPoint servers scour the data and within minutes or less return reports to a central server at the company. Ingenix, Inc. has servers in the PBM data centers, updating the drug files as frequently as once a day. The MedPoint server aggregates the information going back as far as five years, including the drugs and dosages prescribed, dates filled and refilled, the therapeutic class and the name and address of the prescribing doctor. Then comes the analysis; OPTUMInsight’s MedPoint tool provides insurers a “pharmacy risk score,” or a number that represents an “expected risk” for a group of people. Higher scores imply higher medical costs.
According to the Washington Post, OPTUMInsight, Inc. (formerly known as Ingenix, Inc.) reported corporate revenues of $1.3 billion in 2008. In addition to the Ingenix Inc. MedPoint Prescription Profiling, Ingenix Inc.’s other “underwriting and actuarial solutions” include Impact Pro for Underwriting, Ingenix Health Technology Pipeline, Ingenix StepWise Automated Rating, StepWise Medical Underwriter, and Symmetry Pharmacy Risk Groups.