Empowering clients with choice and transparency

For Optum Rx, helping make prescription drugs more affordable for plan sponsors and the members we serve is why we're here.

We also know that each of our customers is unique and best positioned to determine the combination of affordability and transparency solutions that meet their pharmacy benefit needs. That’s why Optum Rx continues to innovate to find new ways to empower client, consumer and provider choice and make prescription drugs more affordable.

For example, Optum Rx offers new expanded payment options in addition to our traditional payment solutions. This includes a new pass-through model that increases transparency and lowers ingredient costs for plan sponsors. We also introduced Cost Clarity, a model that bases costs on independent cost baselines, such as the National Average Drug Acquisition Cost (NADAC) and wholesale costs.

These models continue to align incentives across the supply chain, while providing even greater transparency, choice and customizable pharmacy benefit solutions and maintaining our continued drive for lowest net cost for clients. The new models use a simple administration fee to cover member care and support, benefit setup and administration, client consultation, formulary design, clinical expertise, and safe and affordable medication access.

More ways to drive transparency and affordability in pharmacy benefits

In addition to new payment models, Optum Rx continues to promote choice and competition to help make  expensive biologic drugs more affordable. In February 2023, Optum Rx became the first pharmacy benefit manager to announce it would add a biosimilar to our formulary at parity to Humira® (adalimumab).

Next, we added the first interchangeable and high-concentration adalimumab biosimilars to our formularies. Now, beginning January 1, 2025, Optum Rx will prefer FDA-approved interchangeable adalimumab biosimilars on commercial formularies, bringing copays to $0 for patients while guaranteeing drug supply and availability of all dosage strengths. Plan sponsors will see up to 83% savings per prescription compared to Humira’s list price.

Beyond offering greater choice in pharmacy benefit services for clients, Optum Rx is also empowering consumers to seek out more affordable medications.  Last year, we launched Price Edge, a consumer-friendly solution enabling members to check drug prices in real time. Price Edge seamlessly compares available direct-to-consumer pricing for traditional generic drugs with insurance pricing. Using Price Edge helps  Optum Rx members  get the lowest available prescription drug price — on or off benefit and applied to their deductible. Since  its’ launch,  over 1 million members have enrolled, resulting in more than $4 million in savings on their medications.

These new offerings build on the Optum Rx history of bringing innovation to our clients and consumers to help improve affordability and transparency in pharmacy benefits.

“As our clients’ needs change, we will continue to bring differentiated and responsive solutions that simplify health care while driving cost savings for clients and reducing out-of-pocket costs for our members.”
- Heather Cianfrocco, President, Optum

To learn more about all the ways we are increasing affordability and transparency in pharmacy benefits, talk to your consultant or Optum Rx representative.