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Optum Rx pharmacy benefit management

Making pharmacy benefits more transparent

As the first comprehensive, transparent PBM, we support actionable, verifiable information that helps you understand how your pharmacy dollars are being spent.

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How you benefit from transparency

When partnering with Optum Rx, our comprehensive approach provides plan sponsors with a clear line of sight into how drugs are evaluated, priced and added to a formulary.

Plan sponsors 

We provide plan sponsors with end-to-end transparency from formulary guidance and choice, audit rights and pricing options that align with your plan.

Providers 

We equip providers with the digital tools to see patient-specific cost and coverage information to get members on the best option at the point of care.

Members 

We guide members to the lowest available price and support access through savings alerts.

End-to-end transparency at every step

Clinical-first drug evaluation

Our independent Pharmacy and Therapeutics Committee is comprised of physicians, pharmacists and clinicians.

Formulary choices

Understanding formulary economics is essential to selecting the best formulary option for your plan.

Pricing model choice

Choose and configure a pricing model aligned with your principles that pass through 100% of rebates.

Private-label flexibility

Reach new levels of visibility into drug cost economics when configuring your formulary choices.

Audit rights

We ensure clear reporting and disclosures to give plan sponsors verifiable confidence on their plan as promised.

Pricing guardrails

We have transparent and clearly established pricing guardrails that consider Maximum Allowable Cost (MAC) pricing.

Digital tools for patient access

Physicians and pharmacists can use digital platforms and tools to see real-time costs for their patients.

Consumer advocacy and protection

Total transparency requires giving members new levels of visibility into their pharmacy benefit.

  

Pharmacy regulation updates

We closely monitor what’s happening in pharmacy legislation that has the potential to adversely impact pharmacy benefits offered by fully insured and self-insured clients. Read the latest updates.

Regulations to watch: Spring 2025

Learn what’s at stake for pharmacy benefit sponsors as federal oversight changes and state legislative sessions begin.

View report

Regulations to watch: Fall 2024

Read an assessment of the latest rules impacting PBMs from state and federal legislation and how your voice can be heard.

View report

Regulations to watch: Summer 2024

See what’s coming with the evolving regulatory landscape as lawmakers debate over 600 new bills impacting PBMs.

View report

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Learn more about what it means to have a transparent PBM

Get in touch with our sales team today

Fill out this form and we’ll get back to you shortly.

Need help or account access? View our support resources or sign in.