Optum Rx continues to modernize how pharmacies are reimbursed for drugs. Three additional Pharmacy Services Administration Organizations (PSAOs) representing more than 17,000 community pharmacies are now partnering with Optum Rx to use cost-based contracts.
This is the latest effort from Optum Rx to better support the important role of community pharmacies. With this addition, 100% of community and independent pharmacies in the Optum Rx network have transitioned to the new reimbursement model.
With this change, community pharmacies will have more transparency and financial predictability to manage costs as brand-name drug prices and usage increases.
Breaking it down
Pharmacies buy the medications they dispense to patients. After a patient gets their prescription, the pharmacy is paid back for the dispensed medication.
A long-established, industry-wide system successfully encouraged the use of lower-cost generic drugs, and now generics are common. However, there is an increase in the use of expensive brand-name drugs that is significantly increasing costs for pharmacies. To help pharmacies adapt, the new reimbursement model is designed to better match the rising costs controlled by drug manufacturers. The financial predictability offered through the new model will allow pharmacies to stock more medications and make it easier for people to get the prescriptions they need.
In 2023, drug companies launched new U.S. drugs at prices 35% higher than the previous year. Across brand drugs, manufacturers have set list prices in the U.S. 422% higher than in other nations.
Did you know?
PSAOs are membership-based organizations that contract with, represent and provide administrative support to community pharmacies across the country.
In 2025, Optum Rx increased brand drug reimbursement for 2,300 independent pharmacies – those not affiliated with a chain or larger entity, like a PSAO. In addition, Epic Pharmacy Network (EPN) – representing 1,400 community pharmacies – started a new cost-based reimbursement model with Optum Rx.
“Although this doesn’t solve all the reimbursement issues in the independent pharmacy community, together with EPN, Optum Rx has made an investment in brand reimbursements while preserving generic profitability. It is a meaningful step in the right direction, and we look forward to expanding our partnership with Optum Rx to support our network of pharmacies and their patients.”
Brian Hose | CEO of Epic Pharmacy Network
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