Optum Rx

Optum Rx is a pharmacy care company and one of the largest pharmacy benefit managers (PBMs) in the US. It operates as a subsidiary of UnitedHealth Group, a leading healthcare company. Optum Rx manages prescription drug benefits for health insurers, employers, and government programs. Its core services include negotiating reimbursement rates with pharmacies, creating drug formularies, and processing prescription claims.

In 2023, Optum Rx faced legal challenges from independent pharmacies alleging unfair reimbursement practices. An appeals court ruled in favor of the pharmacies, allowing them to pursue their claims against Optum Rx in a jury trial. The ruling was a significant development in the ongoing disputes between PBMs and pharmacies over pricing transparency and reimbursement rates.

Optum Rx offers home delivery services for prescription medications, enabling patients to receive their maintenance medications through mail order. However, this service is not available in certain US territories.

In May 2024, Optum Rx introduced a new drug pricing model called Clear Trend Guarantee, which aims to provide more predictable pharmaceutical spending for payers by combining various costs into a single per-member price. This value-based model allows Optum Rx to share in any savings tied to improved patient outcomes.

In June 2023, Optum Rx announced initiatives to support independent and rural pharmacies in closing care gaps and improving access to healthcare resources. These programs focused on connecting underserved patients with community resources, enhancing maternal and fetal health, and utilizing community pharmacies in healthcare deserts.