Skip to main content

Empowering clients with choice and transparency

Helping make prescription drugs more affordable for plan sponsors and the members we serve is a universal focus.

May 9,  2023 | 2-minute read


For Optum Rx, helping make prescription drugs more affordable for plan sponsors and the members we serve is a universal focus.

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 is continuing to innovate to find new ways to empower client, consumer and provider choice and make prescription drugs more affordable.

For example, earlier this year Optum Rx began offering 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 costs 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 models use a simple admin fee for 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 historically expensive biologic drugs more affordable. We were first in market to announce a plan to cover biosimilars for Humira. Offering biosimilars as an option gives patients and their doctors the ability to make decisions based on each individual’s needs, while ensuring access to a broader set of effective therapies and lowering costs to payers.

Beyond offering greater choice in pharmacy benefit services for clients, Optum Rx is also empowering consumers to seek out more affordable medications. Earlier this 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. Use of Price Edge helps ensure Optum Rx members always get the lowest available prescription drug price — on or off benefit and applied to their deductible. Since the January launch, just 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 Optum Rx representative.


Learn how we help plan sponsors achieve better health outcomes and lower overall costs

Related content

GLP-1 agonists: A new class of weight loss medications

In this conversation, discover how new weight loss drugs like Wegovy are changing obesity management and their connection to diabetes.

Addressing pharmacy issues that matter to you

From specialty pharmacy to drug affordability, our experts tackle your biggest pharmacy challenges.

Unlocking the promise of personal medicine

See how a peek at your genes enables more precise prescribing.