Optum Rx Raises Brand Drug Reimbursements for Independent Pharmacies
The adjustment took effect on September 1 and is part of a broader push to modernize pharmacy payment structures.
Optum Rx, the pharmacy benefit management arm of UnitedHealth Group, has increased reimbursement minimums for brand drugs across 2,300 independent pharmacies.
The adjustment took effect on September 1 and is part of a broader push to modernize pharmacy payment structures.
The company first announced in March that it would transition to a cost-based model designed to better reflect the expenses pharmacies face due to manufacturer pricing. Optum said the approach aims to strengthen the financial stability of independent and community pharmacies, with a full rollout expected by January 2028.
According to the company, the change "will support the long-term sustainability of pharmacies, which play a critical role in patient care."
In October last year, Optum Rx also introduced new programs to help pharmacies manage costs and patient needs, including the Independent Pharmacy Network. Under contracts selecting this option, pharmacies receive 5% higher reimbursements for generics and 0.2% higher reimbursements for branded drugs.
The company initially piloted improved reimbursement through a partnership with Epic Pharmacy Network, which represents more than 1,000 independent pharmacies.
"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," Optum Rx stated. "Combined, these moves make Optum Rx the first comprehensive, transparent pharmacy services company that passes through savings to its clients and consumers."
