Optum Rx to offer new pricing model

Optum Rx, UnitedHealth Group's pharmacy benefit management company, unveiled a new pricing trend May 20 — following an industrywide trend of increasing transparency on medication costs. 

The pharmacy benefits pricing offering, called Optum Rx Clear Trend Guarantee, "combines guarantees into a single per member cost [and] will offer drug benefit plan sponsors greater predictability of pharmacy spend to help manage total lowest net cost," according to a news release. 

The company said the new pricing model, which will be available January 2025, builds upon its Cost Made Clear payment solutions that feature cost-plus pricing with lower ingredient costs. Clear Trend Guarantee is an alternative that combines retail, home delivery, specialty drug and rebate components into one per member, value-based model. 

"Compared to other models in the market that separate the guarantees, Clear Trend Guarantee ensures plan sponsors have a clear path to a 'bottom line' pharmacy benefits payment to support effective management of drug trend and spending," the release said. "It also leverages outcome-driven, member- or population-level, disease-specific data to identify more effective care pathways for members."

Optum Rx, the third-biggest PBM with its handling of 22% of U.S. prescription claims in 2023, is jumping into a popular movement. Following the increasing disruption status of Mark Cuban Cost Plus Drugs' pricing model, the nation's largest PBMs are now offering similar services as consumers demand more transparency and federal investigators probe the industry.

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