New Optum Rx payment solutions continue to empower clients with more choice, transparency in pharmacy benefits

April 24, 2023

New offerings build on our history of bringing innovation to employers, unions, health plans and consumers to help improve affordability and transparency in pharmacy benefits.

Optum Rx is working to empower consumer and provider choice and make prescription drugs more affordable. Each of our customers is unique and we believe they are best positioned to determine the affordability and transparency solutions that meet their pharmacy benefit needs.


Increasing transparency and choice

In January, Optum Rx began offering expanded payment options that enable choice and drive transparency and affordability in pharmacy benefits to the employer, union and health plan customers we serve. In addition to traditional and pass-through payment solutions we offer today, we now offer additional solutions including:

  • Cost Clarity, a model that bases costs on independent costs baselines, such as the National Average Drug Acquisition Cost (NADAC) and wholesale costs.
  • Cost Advantage, a flexible, pass-through model using average ingredient costs and reflecting real-time network price improvements.

These models continue to align incentives across the supply chain, while providing even greater transparency, choice and customizable pharmacy benefit solutions and maintaining our continued drive for lowest net cost for clients. Clients who choose the new models will also receive member care, formulary design and consultation and additional client support services for an administrative fee.

Enhancing choice and competition to improve affordability

Optum Rx continues to promote choice and competition to make prescription drugs more affordable. We were first in market to announce a plan to cover biosimilars for Humira, which gives patients and their doctors the ability to make decisions based on each individual’s needs, while ensuring access to a broader set of effective therapies and lowering costs to payers.

We also offer greater choice in pharmacy benefit services for clients and clearer benefit navigation and support tools. Earlier this year, we launched Price Edge, a consumer solution that identifies the best available price for prescription drugs. Price Edge seamlessly and in real time compares available direct-to-consumer pricing for traditional generic drugs with insurance pricing to ensure Optum Rx members always get the lowest available prescription drug price – on or off benefit and applied to their deductible. Just over 1 million members have enrolled since the January launch, resulting in more than $4 million in savings on their medications.


“As our clients’ needs change, we will continue to bring differentiated and responsive solutions that simplify health care while driving cost savings for clients and reducing out-of-pocket costs for our members.”

Heather Cianfrocco | chief executive officer, Optum Rx