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Optum Rx rolls out cost-based pharmacy reimbursement model
Healthcare Finance News March 24, 2025
The PBM says the payment model more closely aligns with the costs pharmacies often face due to “manufacturer pricing actions.”
Optum Rx has signaled a shift to a cost-based pharmacy reimbursement model that’s intended to have pharmacies pay more for brand-name drugs and less for generics.
The model will reduce variation in how pharmacies are paid.
The pharmacy benefit manager said the payment model more closely aligns with the costs pharmacies often face due to “manufacturer pricing actions.”
The change will begin immediately and full implementation will be achieved by January 2028, Optum Rx said. Affected pharmacies include more than 24,000 independent community pharmacies.
Optum Rx said the move will also make medications more affordable for consumers.
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