Market-leading approach to client and consumer transparency further aligns incentives across patients and plan sponsors, offering consumers new affordability tools

Company Website: https://www.optum.com/
-- (Business Wire)

Today, Optum Rx announced a new pharmacy care model that fundamentally changes how pharmacy benefits are priced and delivered — replacing traditional approaches tied to drug prices set by manufacturers or prescription volume with a transparent, fee‑based structure offered to every Optum Rx PBM customer. The model is designed to fully align incentives with patients and plan sponsors, bringing greater clarity, predictability and affordability to pharmacy care — supported by digital capabilities that help patients better understand costs and make informed choices.

Dr. Patrick Conway, CEO of Optum, said, “This new Optum Rx model builds on our longstanding commitment to lowering costs and strengthening transparency by offering our clients a simpler and more predictable pharmacy system.”

Under the new approach, Optum Rx clients will be offered a pricing structure with monthly, clearly defined fees per member that are independent of manufacturers’ list prices or prescription volume, eliminating spread pricing and similar practices. Every client will have transparency into Optum Rx fees — including those associated with its group purchasing organization (GPO) — with clear disclosure of payments received from pharmaceutical manufacturers. By the end of 2027, group purchasing will fully transition to flat service fees.

Jon Mahrt, CEO of Optum Rx and Chief Growth Officer of Optum, said, “By combining economic transparency for clients with digital tools that help patients shop for affordable options, we’re delivering a pharmacy system that is simple, easier to navigate and offers greater value.”

In addition to new pricing structures, Optum is launching digital tools that help consumers compare pricing and know the cost of their medication before they go to the pharmacy — making it easier to make informed, cost‑conscious decisions at the point of care:

• Shop MyScript notifies eligible Optum Rx patients immediately after a prescription is written, providing real‑time visibility into pricing, pharmacy options and delivery choices before the prescription is filled. This enables patients to make informed selections earlier in the process and helps reduce prescription abandonment.
  
  
• Price Wise displays a full cost breakdown — including the drug price and a clearly defined service fee — offering an all‑in price through a partner pharmacy. Consumers purchasing medications without using their benefits can see the total cost upfront, without unexpected charges at checkout.

“Greater transparency and predictability in pharmacy benefits helps our industry manage costs more effectively,” said Nancy Price, Vice President Employee Benefits Strategic Sourcing at HealthTrust. “We appreciate Optum Rx for being responsive and collaborative in this effort to advance pharmacy care."

Advancing a modern, affordable pharmacy system built to last

Today’s announcement builds on a series of recent actions Optum Rx has taken to modernize pharmacy care and improve affordability across the system:

• In January 2025, Optum Rx committed to passing through 100% of manufacturer drug rebate discounts to clients by Jan. 1, 2028.
  
  
• Since the beginning of 2025, Optum Rx has eliminated 33% of drug reauthorizations — representing 11% of pharmacy prior authorizations — for a list of nearly 270 chronic condition medications. This list will continue to be reviewed and expanded over time.
  
  
• In March 2025, Optum Rx introduced pharmacy payment terms designed to reflect the actual costs pharmacies incur to deliver care. Through partnerships with Pharmacy Services Administration Organizations (PSAOs), 100% of community and independent pharmacies in the Optum Rx network transitioned to these cost‑based arrangements.
  
  
• In September 2025, Optum Rx increased brand‑name drug reimbursement for 2,300 community and independent pharmacies not affiliated with a PSAO, chain or other entity.

About Optum Rx

Optum Rx^® is a pharmacy care services company reimagining pharmacy benefits to be simpler, more transparent and more affordable. Serving clients and nearly 61 million people, Optum Rx delivers pharmacy care designed to improve health outcomes and lower total cost of care through clear, fee-based pricing, clinical expertise, specialty and infusion services and innovative digital tools that help people make more informed decisions about their medications. With a nationwide network of more than 67,000 community pharmacies and state-of-the-art home delivery pharmacies, Optum Rx is helping reduce friction in pharmacy care and better connect people to the medications they need — at a cost they can understand and trust. Optum Rx is part of Optum^®, an integrated health services company working to help make the health system work better for everyone. For more information, visit optum.com/optumrx.

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Contacts:

Media contact:
optumnews@optum.com

Source: Optum Rx