OptumRx has announced changes to its pharmacy reimbursement model, increasing payments for branded drugs and decreasing payments for generics. The move aims to address industry-wide imbalances and promote the use of affordable generics.
The changes are part of a broader effort by Optum to revamp its business practices in response to criticism from patients, pharmacies, and lawmakers. In recent months, lawmakers have introduced bills aimed at curbing the practice of reducing pharmacy reimbursements and ensuring that Medicaid payments are passed directly to pharmacies.
OptumRx CEO Patrick Conway stated that the new model will help correct imbalances in how pharmacies are paid for brand and generic drugs, promoting greater access to medicines for patients. The changes are effective immediately, with full implementation expected by 2028.
The company is also eliminating annual reauthorization requirements for over 80 drugs, which will reduce more than 10% of pharmacy prior authorizations. This move follows a growing trend in healthcare policy conversations centered around prior authorizations, driven by patient frustration with delayed or denied care.
While overall reimbursement rates won’t change, the adjustments aim to alleviate drug shortages and enable pharmacies to stock more medicines. The changes reflect OptumRx’s commitment to addressing industry-wide issues and promoting greater access to essential medications for patients nationwide.
Source: https://www.axios.com/2025/03/20/optum-pbm-pharmacy-drug-payments