By Robb M. Stewart
UnitedHealth's pharmacy business will shift its payment models to more closely align with the costs pharmacies might face, a move aimed at ensuring medicines are available and better balancing how pharmacies are paid for brand and generic drugs.
The company's Optum Rx unit said Thursday the change will positively affect its non-affiliated network pharmacies, including more than 24,000 independent, community pharmacies.
Optum Rx said the move addresses a legacy, industry-wide model that was originally designed to help promote the use of affordable generic drugs. The adoption of generics is now quite strong and increasingly more high-cost branded drugs are entering the market, raising costs for pharmacies, the business said. It said that addressing this imbalance will provide pharmacies with better financial means to stock more medicines, which will alleviate drug shortages, improve access to medications and deliver a better experience for consumers.
Epic Pharmacy Network, a Pharmacy Services Administrative Organization representing more than 1,000 independent pharmacies in the U.S., has partnered with Optum Rx on a cost-based reimbursement model.
Optum Rx said it will similarly transition client arrangements such as employer and health plan customers - to ensure transparency and greater alignment to drug costs. It has already started implementing the changes, with a goal of completing full implementation by Jan. 1, 2028.
The move is part of what Optum Rx's recent commitment to pass through 100% of drug rebate discounts negotiated with pharmaceutical manufacturers to clients by the start of 2028.
A day earlier, Optum Rx said it is eliminating up to 25% of reauthorizations for prescription drugs to simplify access for consumers.
The reauthorizations being cut are equal to more than 10% of all so-called pharmacy prior authorizations, or the process by which doctors and patients seek insurance approval for healthcare. The effort will first focus on reauthorizations for about 80 drugs, though the company plans to expand the list over time.
Write to Robb M. Stewart at robb.stewart@wsj.com
(END) Dow Jones Newswires
March 20, 2025 07:41 ET (11:41 GMT)
Copyright (c) 2025 Dow Jones & Company, Inc.
Comments