UnitedHealth's OptumRx Unveils New Transparent Drug Pricing Initiative for 2024

UnitedHealth Group‘s UNH OptumRx unit has a new pricing model to help manage drug costs for insurers. 

Starting next year, the OptumRx Clear Trend Guarantee will offer value-based pricing for drugs. It will integrate costs from various sources such as retail pharmacies, home delivery, specialty drugs, and rebates.

Value-based pricing means that payments for medicines will be linked to patient outcomes. This involves insurers, pharmaceutical companies, and pharmacy benefit management (PBMs) like OptumRx.

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This model aims to provide a more transparent and predictable drug pricing structure. It addresses the complexities and ambiguities in the current system, in which out-of-pocket costs are influenced by a multi-tiered network that includes insurers, drugmakers, pharmacies, and PBMs.

This announcement follows OptumRx’s series of measures to promote transparent drug pricing amid growing scrutiny over the role of PBMs in escalating healthcare costs in the United States. 

PBMs manage prescription drug benefits for health insurance companies, large employers, and Medicare prescription drug plans, a group collectively known as payers.

The introduction of the OptumRx Clear Trend Guarantee coincides with similar initiatives from other industry players. 

Reuters noted that CVS Health Corp CVS recently announced its PBM unit, Caremark, will launch TrueCost, a model designed to offer clients greater visibility into prescription drug pricing and administrative fees. 

Last month, Cardinal Health, Inc CAH announced that its pharmaceutical distribution contracts with OptumRx, which expire at the end of June 2024, will not be renewed.

Price Action: UNH shares are up 0.22% at $518.36 during the premarket session at last check Tuesday.

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