Radar on Drug Benefits

Questions Abound About Optum Rx’s Cost-Based Pharmacy Pay Model

  • Mar 27
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    Mar 27, 2025

    Optum Rx’s new pharmacy reimbursement model, which the UnitedHealth Group-owned PBM unveiled on March 20, has been met with mixed reviews. One Wall Street analyst suggested the move could benefit both Optum and retail pharmacies alike, but a trade group representing community pharmacies was far more wary. 

    Whatever the ultimate impact is, the motivation for such a move is clear, says Ge Bai, Ph.D., a business and health policy professor at Johns Hopkins University.  

    “PBM reform is on policymakers’ radar,” she tells AIS Health, a division of MMIT. “Optum seems to be taking a preemptive step to align with what might soon be mandated.” 

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    • Leslie Small

    Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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Lauren Flynn Kelly

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Managing Editor, Health Plan Weekly and Radar on Drug Benefits

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Reporter, Health Plan Weekly and Radar on Drug Benefits

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Carina Belles

Reporter, Radar on Medicare Advantage and Spotlight on Market Access

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Reporter, Health Plan Weekly and Radar on Drug Benefits

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