Optum Rx has announced a new pharmacy care model that fundamentally changes how pharmacy benefits are priced and delivered—replacing traditional approaches tied to drug prices set by manufacturers or prescription volume with a transparent, fee?based structure offered to every Optum Rx PBM customer. The model is designed to fully align incentives with patients and plan sponsors, bringing greater clarity, predictability and affordability to pharmacy care—supported by digital capabilities that help patients better understand costs and make informed choices.

Dr. Patrick Conway, Chief Executive Officer (CEO), Optum, said, “This new Optum Rx model builds on our longstanding commitment to lowering costs and strengthening transparency by offering our clients a simpler and more predictable pharmacy system.”

Under the new approach, Optum Rx customers will be offered a pricing structure with monthly, clearly defined fees per member that are independent of manufacturers’ list prices or prescription volume, eliminating spread pricing and similar practices. Every client will have transparency into Optum Rx fees—including those associated with its Group Purchasing Organisation (GPO)—with clear disclosure of payments received from pharmaceutical manufacturers. By the end of 2027, group purchasing will fully transition to flat service fees.

Jon Mahrt, CEO, Optum Rx and Chief Growth Officer, Optum, said, “By combining economic transparency for clients with digital tools that help patients shop for affordable options, we’re delivering a pharmacy system that is simple, easier to navigate and offers greater value.”

In addition to new pricing structures, Optum is launching digital tools that help consumers compare pricing and know the cost of their medication before they go to the pharmacy—making it easier to make informed, cost?conscious decisions at the point of care.

Shop MyScript notifies eligible Optum Rx patients immediately after a prescription is written, providing real?time visibility into pricing, pharmacy options and delivery choices before the prescription is filled. This enables patients to make informed selections earlier in the process and helps reduce prescription abandonment.

Price Wise displays a full cost breakdown—including the drug price and a clearly defined service fee—offering an all?in price through a partner pharmacy. Consumers purchasing medications without using their benefits can see the total cost upfront, without unexpected charges at checkout.

Nancy Price, Vice President, Employee Benefits Strategic Sourcing, HealthTrust, said, “Greater transparency and predictability in pharmacy benefits helps our industry manage costs more effectively. We appreciate Optum Rx for being responsive and collaborative in this effort to advance pharmacy care."