Share Copy link Email LinkedIn X/Twitter Facebook Print Optum Rx will shift away from a pharmacy benefits model where it’s reimbursed based on the list price of medications, in a bid to boost transparency amid heightened scrutiny of what critics say are opaque business practices by pharmacy benefit managers. Under the new model, clients of the UnitedHealth-owned PBM will be able to pay “monthly, clearly defined fees” per member that aren’t linked to drug manufacturers’ list prices or prescription volume, Optum Rx said in a press release Monday. Customers will be able to view Optum Rx’s fees, including those linked to the company’s Emisar group purchasing organization and payments received from pharmaceutical companies. Group purchasing will transition to flat service fees by the end of next year, Optum Rx said. The move by UnitedHealth’s pharmacy benefits unit comes a…

The Big Three control about 80% of prescription claims in the U.S. The Federal Trade Commission sued the nation’s largest PBMs — Optum Rx, CVS’ Caremark and Cigna’s Express Scripts — in 2024, accusing the drug middlemen of driving patients toward more expensive insulin to bring in higher rebates from drugmakers. Express Scripts reached a settlement with the regulator earlier this year. PBMs have also drawn the ire of lawmakers. In February, President Donald Trump signed a funding bill that included reforms for the drug middlemen, including transparency requirements and a prohibition on PBMs’ linking their pay to manufacturers’ list prices in Medicare Part D. Some of Optum Rx’s peers, like Cigna and CVS, have also overhauled their pharmacy benefits models. Now, the UnitedHealth-owned PBM is changing its approach too, which should make its pharmacy system “simpler and m…