UnitedHealth Group's pharmacy benefit manager, Optum Rx, is making the shift to a more transparent model, the company announced Monday.
Optum said the new model will shift away from traditional models tied to manufacturer pricing or prescription volume and instead use a fee-based structure. Optum Rx clients will see monthly, clearly defined fees per member, with greater transparency into those fees.
Through the new model, Optum said it will nix spread pricing and other similar models. Clients will also have more insight into fees through its group purchasing organization, with its GPO switching fully to flat service fees by the end of next year.
“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," Optum CEO Patrick Conway said in the announcement.
In addition to the new PBM model, Optum said it will launch new digital tools that will make it easier for members to find pricing information before they reach the pharmacy counter and to compare prices.
Through the ShopMyScript tool, customers are immediately notified when a prescription is submitted, with real-time details on pricing and options for pharmacy pickup or delivery, before the script is filled. By reaching out earlier in the process, patients can make informed choices sooner, averting prescription abandonment, Optum said.
In addition, the Price Wise tool will provide a full cost breakdown, including the price of the drug and fees, to make the all-in price clear to the member upfront. For people who choose to purchase a medication without using their benefit, they can also see the upfront cost with no surprises at checkout, 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," said John Mahrt, CEO of Optum Rx and chief growth officer at Optum, in the announcement.
Optum said the news comes on the heels of several other steps the company has taken to modernize its pharmacy models. In January 2025, Optum Rx said that it will pass through 100% of drugmaker rebates by Jan. 1, 2028. The PBM has also eliminated 33% of drug reauthorizations since the beginning of last year.
Optum has also established new pharmacy reimbursement terms and late last year announced it would boost payments to community and independent pharmacies that are not affiliated with Pharmacy Services Administration Organizations.
Cigna's PBM Express Scripts announced late last year that it would also move away from rebates, meaning that two of the industry's "Big Three" have made the shift. In February, legislators finally passed substantive PBM reforms after years of talk, adding additional pressure to rethink existing paradigms.