Business
Optum Rx to Modernize Pharmacy Payment Models
March 20, 2025--Rising prices set by pharmaceutical companies are causing pharmacies across the United States to pay more for many drugs, impacting their ability to maintain high-quality care for patients.
About this update from Unitedhealth Group Incorporated
[{"type":"text","content":"March 20, 2025--(BUSINESS WIRE)--Rising prices set by pharmaceutical companies are causing pharmacies across the United States to pay more for many drugs, impacting their ability to maintain high-quality care for patients.","length":222,"tagName":"p"},{"type":"text","content":"Effective immediately and with full implementation by January 2028, Optum Rx will align payment models more closely to the costs pharmacies may face due to manufacturer pricing actions. This change will positively impact Optum Rx non-affiliated network pharmacies, including the more than 24,000 independent, community pharmacies we serve. These cost-based payment models will also provide more consistently affordable experiences for consumers.","length":445,"tagName":"p"},{"type":"text","content":"With this change, Optum Rx is addressing a legacy, industry-wide model that was originally designed to help promote the use of affordable generics. Effective generic adoption is now quite strong, and increasingly, more high-cost branded drugs are entering the market, raising costs for pharmacies. Addressing this imbalance will provide pharmacies with better financial means to stock more medicines, which will alleviate drug shortages, improve access to medications and deliver a better experience for consumers.","length":514,"tagName":"p"},{"type":"text","content":""Pharmacies and pharmacists provide important care to patients, and we recognize that increasing drug prices make it hard for them to afford needed medicines, especially independent and community pharmacies," said Patrick Conway, M.D., chief executive officer of Optum Rx. "This move will help correct imbalances in how pharmacies are paid for brand and generic drugs and will ensure greater access to medicines for patients across the country."","length":465,"tagName":"p"},{"type":"text","content":"Epic Pharmacy Network, Inc. (EPN), a Pharmacy Services Administrative Organization representing over 1,000 independent pharmacies across the U.S., has partnered with Optum Rx to pursue a cost-based reimbursement model.","length":218,"tagName":"p"},{"type":"text","content":""Our pharmacists are critical partners in care and often the most consistent health care provider for the patients and communities they serve," said Bretta Grinsteinner, EPN. "This move by Optum Rx is a signific...