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Pharmacy benefit management

Driving appropriate utilization of medications

We are committed to helping members stay adherent to medications while addressing the industry challenges that prevent them from doing so.

Caring for members

Delivering better health through the pharmacy benefit

We are dedicated to helping members stay adherent to the medications they need while tackling the pharmacy industry challenges that impact them – from the opioid epidemic to the quality, safety and cost effectiveness of their medication regimens.

Pharmacy solutions that make a difference

Polypharmacy

Simplifying complex therapies through collaboration

38 million working Americans are at-risk for complications due to overprescribed medications. That’s where the Optum Rx Polypharmacy Value Management Program can help. By targeting members taking five or more chronic medications, clients can expect to save an average of $1,300 per successful intervention.1

Opioids

Addressing the epidemic with powerful results

Opioid misuse continues to be a national health care crisis.2 3 million Americans have opioid use disorder with only 2% receiving treatment.3 The Optum Rx Opioid Risk Management offers a comprehensive solution for prevention, engagement, smart prescribing, and ongoing monitoring.

Helping members stay adherent

Better choices driven by a continuum of care

The Optum Rx Meds on Track program drives better clinical outcomes for members through a personalized, multi-channel care approach. From engagement to education and counseling, medication monitoring and gaps in care closure, we meet members where they are.

Fighting bad actors to save pharmacy costs

Our goal is to prevent, detect and correct fraud, waste and abuse

Every year, plan sponsors lose up to $300 billion in health care fraud, waste, and abuse.4 Optum Rx Audit Services run 24/7 behind-the-scenes at no cost to our clients. This latest case study shows how we recovered $315,000 within six months for a nursing union representing 1.2 million lives.5

Multiple quality checks

Ensure orders are dispensed, packaged, and shipped safely

When it comes to prescription safety, triple checking is not enough. Our advanced automation combined with multiple safeguards and quality checks throughout the process helps ensure members receive the right medication with a 99.998% dispensing accuracy rate.6

Key benefits

 Driving appropriate medication utilization helps control costs for both you and your employees.

Polypharmacy

$1,300 plan savings per intervention of members taking five or more chronic medications.7

Award-winning Opioid Risk Management Program

Using our five-pronged approach, 96% opioid claims are compliant with CDC guidelines.8

Meds on Track

69% of members move from nonadherent to adherent in six months resulting in $24 per intervened member per month total cost savings.9

Fraud, waste and abuse

By terminating 45 pharmacies within our network, we generated $80 million in cost avoidance for Labor and Trust clients.10

Pharmacist reviews

Multiple quality checks result in a 99.998% dispensing accuracy rate.11

Related healthcare insights

Article

The dangers of polypharmacy

Millions of workers at risk due to overprescribed drugs.

Article

How to manage medication overload

Hear from a leader's perspective on how to manage polypharmacy.

Case study

Fighting fraud how plan sponsor recovered funds

How one plan sponsor recovered $315,000 in six months.

Drive appropriate medication utilization in your pharmacy benefit plan.

Complementary solutions

Caring for pharmacy members

We promise to deliver simple ways for your employees to get the medication they depend on – while advancing health equity for everyone.

Redefining the PBM experience

We are creating a simplified, more connected health care experience for you, your members, and the providers who care for them.

Using data to improve health equity

Everyone deserves access to affordable healthcare. Learn how we’re using data and analytics to identify disparities and take steps toward health equity for pharmacy members.

1. Optum Rx internal data: January – June, 2021. Results are illustrative and are not guaranteed.
2. SAMHSA. Key Substance Use and Mental Health Indicators in the United States. 2021. Results from the 2020 National Survey on Drug Use and Health. Accessed April 20, 2022 at Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (samhsa.gov)
3. NCBI. Opioid Addiction. Martin R. Huecker; Mohammadreza Azadfard; James M. Leaming. Updated June 29, 2020. https://www.ncbi.nlm.nih.gov/books/NBK448203/ 3 million US citizens and 16 million citizens worldwide have had or currently suffer from opioid use disorder.
4. National Health Care Anti-Fraud Association. The Challenge of Health Care Fraud. Accessed April 6, 2022.
5. Optum Rx analysis of recoveries under Standard Fraud, Waste and Abuse Audit Services in quarters 1 and 2, 2021.
6. Optum home delivery book of business dispensing accuracy rate 2023.
7. 2022 Optum Rx internal analysis on Polypharmacy Value Management. Q3 2022 BOB outcomes by 11/4/2023. 6 POC Pilot Clients (674,175 Lives).
8. Percentage based on 2022 opioid metrics reporting for Optum Rx opportunity book defined as direct commercial non-MCO clients.
9. Optum Rx analysis. Metrics based on 2021 Meds on Track book of business client data for top 3 conditions. Nonadherence is defined as someone taking their medication less than 80% of the time during the measured time period, or Proportion of Days Covered (PDC).
10. Optum Rx analysis of book of business comparing 2019 to 2020 results.
11. Optum home delivery book of business dispensing accuracy rate 2023.