All community and independent pharmacies in the Optum Rx network have transitioned to a cost-based reimbursement model aimed at improving payment transparency and stability.
The shift follows new agreements with three pharmacy services administration organizations, which represent more than 17,000 pharmacies, according to a Dec. 18 news release. With these additions, Optum Rx’s entire pharmacy network is now operating under the updated model.
The new model is part of a broader overhaul of pharmacy payment practices. Since March, Optum Rx has introduced cost-based reimbursement, raised brand-name drug payments, lowered generic rates and increased minimum reimbursements for more than 2,000 independent pharmacies. The company said the approach better reflects actual acquisition costs and helps pharmacies manage rising prices of brand-name drugs.
The changes also align with other 2025 initiatives by Optum Rx to streamline access to medications, including removing reauthorization requirements for 180 drugs and expanding automated prior authorization tools across 20 health systems.
