Pharmacy benefits are inherently dynamic: Ever-increasing list prices set by drug manufacturers, changing regulations and shifting utilization trends make multi-year budget planning even more of a challenge.
That is why plan sponsors need a partner with the dedication and depth of resources to make pharmacy benefits more affordable and predictable.
Managing prescription drug costs requires more than securing competitive prices. Plan sponsors need a pharmacy care services provider that can manage high-cost drug categories, anticipate market changes and use technology to optimize prescription drug utilization in real time.
The image depicts how Optum Rx helps control prescription costs via 3 primary avenues. One, better price and rebate terms. Two, real-time pharmacy insights into pricing changes and supply disruptions. Three, deep clinical expertise to manage high-cost drugs and specialty medications.
Optum Rx uses a range of capabilities unique in the industry to help stabilize costs and provide plan sponsors with long-term prescription drug pricing insights. Our scale allows us to negotiate competitive drug prices and rebate agreements with manufacturers. It also helps us secure pharmacy reimbursement rates that many plan sponsors could not access on their own.
When pricing changes, regulatory disruptions or supply chain shocks impact the market, we are equipped to anticipate and manage those disruptions in ways other organizations cannot. This provides the stability and predictability plan sponsors need to manage long-term benefit strategies.
Clinical depth adds another critical layer of budget protection. Rising specialty drug spending, GLP-1 medications for weight loss, gene therapies and chronic condition management all represent significant and growing cost drivers. Our deep industry expertise is instrumental in producing the innovative solutions and clinical programs needed to control these costs and improve member health outcomes. This helps plan sponsors stay ahead of trend rather than reacting to it.
The ability to invest in technology affects cost, member experience and administrative efficiency in pharmacy benefits. We have invested in the robust data and analytics infrastructure necessary to provide:
In 2026, we launched Optum Assistant, a platform-level innovation delivering smarter guidance to members. Built on an enterprise-spanning AI development ecosystem, Optum Assistant is a digital companion that understands user intent. It reduces friction by anticipating member needs to provide real-time, personalized guidance across the pharmacy benefit experience.
One of the most underappreciated drivers of pharmacy cost growth is prescription abandonment. When members first learn the cost of their medication after they arrive at the pharmacy, they are more likely to skip necessary care. Our new digital tools are designed to move cost awareness earlier in the process, where members can act on it.
Shop MyScript engages eligible members immediately after a prescription is written, providing real-time pricing and pharmacy options. Through a secure digital experience, members can view their medication, compare in‑network pharmacy options and see personalized, estimated out‑of‑pocket costs before the prescription is filled. This early engagement can translate into better patient adherence outcomes and lower downstream medical costs for plan sponsors.
Fragmented healthcare models can create operational challenges and increase costs. For plan sponsors looking to reduce cost and complexity, pharmacy integration matters. It can:
Optum Rx coordinates pharmacy benefits through a single operating model that includes:
Clinical, technology, data and service teams work together to deliver a more connected experience. As a result, plan sponsors benefit from a more efficient and streamlined system.
Members also benefit from greater coordination. For example, Optum Rx is using its data and clinical expertise to improve the prior authorization process for certain long-term medications. Since the beginning of 2025, Optum Rx has eliminated 33% of drug reauthorizations, representing 11% of pharmacy prior authorizations. This reduces barriers to care, helps avoid treatment interruptions and lowers related administrative costs.
Optum Rx is advancing our industry-leading transparency initiatives with our latest pharmacy care model. Designed to give plan sponsors clear visibility into what they pay and confidence that our incentives are aligned with theirs, the new model represents a true alternative to legacy pricing mechanisms.
Featuring a clearly defined, fee-based cost structure independent of drug price fluctuations in the broader market and the complexities of spread pricing, the model offers plan sponsors the predictability they need to budget effectively. The transparent pharmacy care model is part of a broader Optum Rx commitment to create a modern pharmacy benefit where clarity and simplicity are foundational principles, not aspirational goals.
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