Optum Rx Adopts Cost-Based Payment Model To Support Pharmacies

(RTTNews) - Optum Rx - a subsidiary of UnitedHealth Group Incorporated (UNH) Thursday announced that it is revising its pharmacy payment model to better reflect rising drug costs, ensuring fair reimbursement for pharmacies affected by increasing manufacturer prices.

The full implementation of this cost-based model is expected by January 2028, benefiting over 24,000 independent community pharmacies and improving affordability for consumers.

This shift moves away from outdated reimbursement models, originally designed to promote generic drug adoption, which no longer align with today's high-cost branded drug landscape. The new approach aims to increase medication availability, reduce shortages, and improve patient access.

Patrick Conway, CEO of Optum Rx, highlighted the importance of pharmacists in patient care and emphasized that correcting reimbursement imbalances will enhance medicine accessibility nationwide. Epic Pharmacy Network, Inc., representing 1,000+ independent pharmacies, has partnered with Optum Rx to support this transition.

Additionally, Optum Rx is aligning employer and health plan client arrangements with these cost-based changes while committing to passing 100% of negotiated drug rebate discounts to clients by January 2028.

To further support pharmacies, Optum Rx is implementing several initiatives, including compensating pharmacists for services that assist underserved patients, paying independent pharmacists for counseling and medication management, enhancing digital tools to streamline claims and payment processing, eliminating retroactive recoupments ("clawbacks"), and providing predictive analytics to reduce administrative burdens, allowing pharmacists to focus more on patient care.

These efforts position Optum Rx as a leader in transparent, pharmacy-supportive services, ensuring fair compensation and improved patient experiences across the U.S.

Thursday UNH closed at $511.3 or 1.61% higher and is currently trading after hours at $510.5 or 0.16% lower on the NYSE.