Pharmacy benefit management solutions, built for you

As the first comprehensive, transparent pharmacy services provider, we don’t ask you to trust our decisions — we show you how they’re made. You can see the ‘how’ and the ‘why’ (and what it means) as decisions are made, not after the fact. That means guaranteed transparency for:

• Every formulary decision
• Every pricing strategy
• Every trend-management initiative

For example, every formulary decision begins with our open and independent Pharmacy & Therapeutics Committee. Comprised of independent physicians, pharmacists and clinicians, the committee appraises new and existing medications based on clinical evidence. They then determine whether a medication has a unique therapeutic benefit or whether the risk of harm outweighs the benefits. These reviews are open, and as a client, you can request to attend.

Our pricing is based on open-book financial models, giving you 100% visibility into net cost and a $0 margin on drugs with pass-through pricing. Also:

• No hidden fees: If a client wants to make changes to their benefit, any applicable cost or fees would be discussed at that time.
• Transparency into benefit changes: We provide regular benefit-change recommendations to clients and proactively notify members of any negative changes. Members also have ongoing access to current plan information through our app, website and call centers.
• Transparency into your benefit plan: Optum Rx Benefit Central provides clients with real-time data reporting and insights. Interactive dashboards provide trend drivers, plan performance, drug and member detail and more.

This guaranteed transparency extends not just to clients, but also to providers and members. Providers use our PreCheck MyScript® tool, which provides plan- and member-specific coverage, pricing and lower cost alternatives at the point of prescription.

Consumers benefit from lowest available price and proactive savings alerts. These proactively identify the lowest available price we can offer.

For example, members save an average of $90 per switch with MyScript Finder™ and $214 per prescription when using PreCheck MyScript.¹

Understanding real-time costs, savings and alternatives upfront means fewer disruptions, faster access and better care experiences.

When we say “scale,” we mean:

• Our buying power works for you.
• Our technology investment works for you.
• Our clinical expertise works for you.

And our economics are structured so you can understand and stand behind them.

Optum Rx is uniquely positioned to combine scale with transparency and alignment. We have the purchasing power and infrastructure of the largest pharmacy benefit managers — without requiring clients to accept ‘black box’ economics to access it.

Buying power

Our purchasing scale allows us to negotiate aggressively across brands, specialty and biosimilars — and translate that leverage into lower net cost and protection against volatility.

Technology investment

We invest billions in analytics, AI, digital tools and automation. That means you get:

• Predictive trend modeling
• Effective specialty management
• Real-time benefit tools
• Proactive clinical interventions

This helps lower administrative burden and facilitate smarter decisions.

Clinical & operational depth

We have the infrastructure — pharmacists, clinicians, data scientists and service teams — to bring complex strategies to bear, broadly and consistently.

Alignment

All large PBMs have scale. The question is: Who benefits from it? We’ve aligned ours — transparently — so the value flows to clients, not to enterprise platforms.

Practically speaking, our aligned scale pays off across the board. For example, we help drive:

• 3x faster claims processing
• 68% reduction in prior authorization denials with PreCheck Prior Authorization
• Average member savings of $90.28 when members use MyScript Finder.^{2, 3, 4}

In sum, scale alone isn’t the difference. Aligned scale is.

We’ve stressed how complex the modern pharmacy benefit landscape has become. That means decision makers increasingly require expert support — not just information. Leaders are making choices in real time as clinical trends shift, member needs evolve and cost pressures intensify.

If the insight you’re getting only explains what already happened instead of guiding what comes next, you’ll have a harder time staying ahead of risk and acting with certainty.

From Insight to Action is about providing actionable insights that can help create better outcomes. Not just more data, but decision-ready guidance shaped by advanced analytics, AI and experienced clinical and service teams. Risks and options surface earlier, so you can move faster and with greater confidence — even as conditions change.

Through tools like Benefit Central, Optum Assistant and MyScript Finder, complex benefit and clinical information is translated into guidance that’s easy to act on and easy to measure. Using AI‑powered plan diagnostics, AI‑enabled fraud detection and adherence interventions, we identify early signals that others miss.

From Insight to Action means guidance you can trust, decisions you can stand behind and outcomes that move healthcare forward for everyone.

At Optum Rx, every insight is clinically grounded, partnership‑driven and powered by advanced technology. Here are a few examples of how this shows up in real outcomes:

• $2M recovered per client on average in fraud, waste and abuse using AI risk detection⁹
• 19% PMPM savings for clients with value-driven formulary and utilization management programs — when our guidance is deployed, clients see meaningful cost improvement⁵
• $60+ average member savings with Price Edge in 2025 — turning our scale into real-time savings⁶
• <30 seconds average prior authorization approval time — automation is used to remove friction⁷
• 25% reduction in re-authorizations, totaling more than 10% of overall pharmacy prior authorizations⁸

The question isn’t whether the market will change. It’s whether your pharmacy benefit partner is built for change. Our partnership starts with you and is grounded in clarity, alignment and outcomes. We’re committed to addressing your unique challenges and providing cost-effective solutions to maximize access and affordability.