Explore how pharmacy care services provide whole-person care that aligns pharmacy and medical needs to achieve the lowest net costs, decrease total cost of care, improve health outcomes and simplify the consumer experience.

Transforming Pharmacy Care Services

Pharmacy is the most frequent touchpoint in health care. UnitedHealth Group’s pharmacy care services approach includes:

  • Promoting use of clinically effective, lowest-net cost prescription drugs;
  • Enabling the use of low-cost alternatives, including generics, biosimilars, and affordable brand medications;
  • Offering medication home delivery and creating high-quality networks of affordable pharmacies;
  • Negotiating discounts from drug manufacturers and drugstores;
  • Managing high-cost specialty medications;
  • Developing clinical programs to help consumers manage prescription drugs effectively;
  • Reducing waste and improving adherence;
  • Implementing value-based pricing; and
  • Connecting pharmacy to other health care engagements to lower total cost of care.

We are committed to advancing solutions to improve affordability across the health care system, and to protect consumers from rising drug prices and high out-of-pocket costs.

Our pharmacy care services business, OptumRx, is working to ensure consumers have access to the most affordable and clinically appropriate drugs and is helping plan sponsors pay the lowest net cost. For example, OptumRx, in collaboration with UnitedHealthcare, expanded pharmacy discounts to millions of Americans when they fill prescriptions through retail pharmacies or home delivery.  Expanding access to discounts builds on a history of introducing innovative approaches, products and services designed to improve personal health and enable consumers to directly benefit from the full value of their pharmacy benefits.

Research Shows Pharmacy Benefit Management Can Generate Significant Savings for Medicaid

Medicaid programs increasingly rely on PBMs to manage drug benefits for Medicaid beneficiaries, whether they have health plan or fee-for-service coverage. A UnitedHealth Group research report finds that pharmacy benefit management can save Medicaid drug programs over $110 billion.

PBMs generate significant savings for Medicaid by:

  • Driving use of the highest therapeutic quality, lowest-cost drugs and shifting utilization from brands to generics as clinically appropriate;
  • Developing preferred pharmacy networks;
  • Advancing evidence-based, clinically effective utilization; and
  • Leveraging data analytics to detect and prevent fraud, waste, and abuse.

Nationally, PBMs saved Medicaid $22 billion from 2013 to 2018. These savings represent only a portion of the potential savings achievable through optimal use of pharmacy benefit management in Medicaid. If all states were to fully utilize these PBM tools and capabilities, PBMs could save Medicaid more than $110 billion.