{"id":827875,"date":"2025-03-20T07:04:25","date_gmt":"2025-03-20T11:04:25","guid":{"rendered":"https:\/\/www.marketnewsdesk.com\/index.php\/optum-rx-to-modernize-pharmacy-payment-models\/"},"modified":"2025-03-20T07:04:25","modified_gmt":"2025-03-20T11:04:25","slug":"optum-rx-to-modernize-pharmacy-payment-models","status":"publish","type":"post","link":"https:\/\/www.marketnewsdesk.com\/index.php\/optum-rx-to-modernize-pharmacy-payment-models\/","title":{"rendered":"Optum Rx to Modernize Pharmacy Payment Models"},"content":{"rendered":"

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Optum Rx to Modernize Pharmacy Payment Models<\/b><\/p>\n

–(BUSINESS WIRE<\/a>)–
\nRising prices set by pharmaceutical companies are causing pharmacies across the United States to pay more for many drugs, impacting their ability to maintain high-quality care for patients.\n<\/p>\n

\nEffective immediately and with full implementation by January 2028, Optum Rx will align payment models more closely to the costs pharmacies may face due to manufacturer pricing actions. This change will positively impact Optum Rx non-affiliated network pharmacies, including the more than 24,000 independent, community pharmacies we serve. These cost-based payment models will also provide more consistently affordable experiences for consumers.\n<\/p>\n

\nWith this change, Optum Rx is addressing a legacy, industry-wide model that was originally designed to help promote the use of affordable generics. Effective generic adoption is now quite strong, and increasingly, more high-cost branded drugs are entering the market, raising costs for pharmacies. 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.\n<\/p>\n

\n\u201cPharmacies and pharmacists provide important care to patients, and we recognize that increasing drug prices make it hard for them to afford needed medicines, especially independent and community pharmacies,\u201d said Patrick Conway, M.D., chief executive officer of Optum Rx. \u201cThis move will help correct imbalances in how pharmacies are paid for brand and generic drugs and will ensure greater access to medicines for patients across the country.\u201d\n<\/p>\n

\nEpic Pharmacy Network, Inc. (EPN), a Pharmacy Services Administrative Organization representing over 1,000 independent pharmacies across the U.S., has partnered with Optum Rx to pursue a cost-based reimbursement model.\n<\/p>\n

\n“Our pharmacists are critical partners in care and often the most consistent health care provider for the patients and communities they serve,\u201d said Bretta Grinsteinner, EPN. \u201cThis move by Optum Rx is a significant step forward in changing the reimbursement model for our pharmacies, who continue to struggle with the rising costs of medications. EPN is committed to working alongside Optum Rx in their efforts to address reimbursement issues that plague pharmacies nationwide.\u201d\n<\/p>\n

\nIn parallel, Optum Rx will similarly transition client arrangements – such as employer and health plan customers – to ensure transparency and greater alignment to drug costs. We have already started implementing these changes, with the goal of completing full implementation by January 1, 2028.\n<\/p>\n

\nThese changes build on our recent commitment to pass through 100% of drug rebate discounts negotiated with pharmaceutical manufacturers to clients by January 1, 2028. Combined, these moves make Optum Rx the first comprehensive, transparent pharmacy services company that passes through savings to its clients and consumers.\n<\/p>\n

Supporting Pharmacies Across the U.S.<\/b><\/p>\n

\nOptum Rx has been working to ensure pharmacies are paid fairly and offering solutions to improve operational efficiency and reduce administrative burden so they can spend more time caring for patients. Some of these efforts include:\n<\/p>\n