Optum Rx outlines changes to PBM business model, promising price transparency
UnitedHealthGroup said its pharmacy benefit manager unit, Optum Rx, will be “strengthening transparency” by shifting its business operations in terms of how services and drugs are "priced and delivered.”
In an announcement, Optum said it would be moving away from pricing structures tied to prescription volume or manufacturer pricing, instead using a supply-and-demand fee-based model that would be more equal for all its customers.
Optum said this would come in the form of a change to the monthly fees charged to clients, providing itemized invoices that explain fee differences.
As part of the change, the company said it was “committed to passing through 100% of manufacturer drug rebate discounts to clients by Jan. 1, 2028,” a promise it made in 2025.
Notably, the complicated nature of manufacturer rebates—and those being passed on to preferred pharmacies within the vertical—have been a major sticking point for regulators looking into PBM business practices. Optum is at least implying in its declaration that those will be distributed more transparently, or at least transparently.
“This new Optum Rx model builds on our longstanding commitment to lowering costs and strengthening transparency by offering our clients a simpler and more predictable pharmacy system,” Patrick Conway, MD, CEO of Optum, said in a statement.
As part of this commitment, Optum confirmed its group purchasing organization—also part of the UnitedHealth vertical—will switch to a flat pricing model for drug buys by the end of the year. This should mean more stable prices for all pharmacies and health plans that rely on Optum for pharmaceuticals.
New digital tools
As part of the new distribution model, Optum stated that it will be launching new “digital tools” to aid members looking for the best prices. The company said the system will allow plans and customers to compare prices from various pharmacies, to find the best deal.
This would happen before a prescription is filled, with the ability of patients to follow the entire process through to fulfillment via the platform, Optum said. This includes details on how insurance benefits impact prices.
“By combining economic transparency for clients with digital tools that help patients shop for affordable options, we’re delivering a pharmacy system that is simple, easier to navigate and offers greater value,” John Mahrt, CEO of Optum Rx and chief growth officer at Optum, said.
The news on the change comes after the Federal Trade Commission (FTC) sued the PBM—along with its two largest competitors—in 2024. The agency paused the lawsuit, seeking settlements with the companies that involved certain concessions similar to what is listed above.
The FTC was particularly concerned with how manufacturer rebates were leveraged to control the price of insulin. Optum did reference this in its announcement, but the changes could be enough to alleviate the concern of regulators.
The full announcement from the company is available here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.