Optum Rx’s PBM Pricing Model May Have Hidden Costs

Experts say they’re skeptical that a pricing tool unveiled on May 20 by Optum Rx, UnitedHealth Group’s PBM division, will make significant changes to the PBM business model or generate major savings for plan sponsors. Indeed, some experts say that the model, Clear Trend Guarantee, could in practice be used to obscure rebate revenue that plan sponsors would otherwise collect. 

According to a UnitedHealth press release, the new product “combines guarantees into a single per member cost” that “will offer drug benefit plan sponsors greater predictability of pharmacy spend to help manage total lowest net cost.”