Optum Rx, one of the largest pharmacy benefit managers in the U.S., has increased reimbursement minimums for brand drugs for approximately 2,300 independent pharmacies.
The initiative builds on the company's commitment earlier this year to modernize its pharmacy payment model. Optum Rx said in March it would shift to a cost-based model, which will better align with "the costs pharmacies may face due to manufacturer pricing actions."
The PBM said it expected the transition to a cost-based model would be a positive change for the more than 24,000 independent and community pharmacies it works with, along with its members. Optum began to roll out the updated models a few months ago, and it intends to have a full implementation in place by January 2028.
Optum Rx is the pharmacy services business within the broader Optum division of UnitedHealth Group.
The rollout of the new reimbursement minimums for brand drugs will benefit more than 2,000 independent pharmacies, or those not affiliated with a pharmacy services administrative organization, chain or other entity. The change, which went into effect Sept. 1, "will support the long-term sustainability of pharmacies, which play a critical role in patient care," Optum Rx said in a press release.
In October, Optum Rx unveiled a slate of new programs that aim to support independent pharmacies in managing costs and more complex patient needs. The first offering under this initiative was Optum's new Independent Pharmacy Network, which is available as an add-on for its PBM clients. In contracts that select this option, independent and community pharmacies will receive 5% higher reimbursements for generics and 0.2% higher for branded drugs, the company said.
Existing payment approaches were designed initially to encourage the use of generics, which have now been widely adopted, Optum Rx executives said back in March. Instead, high-cost branded therapies are coming to market, which can stretch independent pharmacies thin. Adjusting payment models to center on drug costs should make it easier for these pharmacies to stock medications, mitigating shortages and improving access.
Optum Rx first launched improved reimbursement with Epic Pharmacy Network, a pharmacy services administrative organization representing more than 1,000 independent pharmacies that chose to partner with the company to pursue the cost-based model.
The company said it was making this investment to support the "long-term sustainability of pharmacies—especially independents that serve vulnerable communities without the scale or resources of larger entities."
" As brand drug utilization continues to grow alongside manufacturer-set prices, this positive change will help ensure that prescriptions filled by independent pharmacies are reimbursed at a positive margin. Combined, these moves make Optum Rx the first comprehensive, transparent pharmacy services company that passes through savings to its clients and consumers," the company said in the press release.