UnitedHealth : Optum Rx announces new pricing model to offer clients another transparent, predictable way to manage drug trend (2024)

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Building upon Cost Made Clear payment solutions announced last year, Optum Rx continues to lead the industry with innovative, varied solutions that support demand for transparency and choice while addressing rising drug trend. Optum Rx Clear Trend Guarantee™, a pharmacy benefits pricing solution that combines guarantees into a single per member cost, will offer drug benefit plan sponsors greater predictability of pharmacy spend to help manage total lowest net cost.

Current U.S. drug spend is more than $711 billion, up from $493 billion in 2018 and expected to top $1 trillion in 2028. As stakeholders in health care call for more transparency and value to combat rising drug prices set by drug manufacturers, the Optum Rx pharmacy benefit manager (PBM) continues to expand choice and tailor how pharmacy benefits can meet the demands and budgets for benefit plan sponsors and people they represent.

The Optum Rx Cost Made Clear solutions, available to plan sponsors today, include pass-through models that offer cost-plus pricing with lower ingredient costs. Clear Trend Guarantee is an alternative, guarantee-based pricing model that combines retail, home delivery, specialty drug and rebate components into one per member guarantee. Compared to other models in the market that separate the guarantees, Clear Trend Guarantee ensures plan sponsors have a clear path to a "bottom line" pharmacy benefits payment to support effective management of drug trend and spending. This will ultimately deliver value to individuals and families who want predictability in their premiums and drug costs.

Clear Trend Guarantee is a value-based model with shared savings to promote efficient care. It also leverages outcome-driven, member- or population-level, disease-specific data to identify more effective care pathways for members.

Beginning January 1, 2025, Optum Rx PBM will offer Clear Trend Guarantee to drug benefit plan sponsors alongside a full suite of Cost Made Clear payment solutions and the traditional and pass-through models currently available.

• 27%Network: Plan sponsors save 27% - or $43 billion - with negotiated Optum Rx network pharmacy rates.
• $43BRebates: We aggregate volume and manage utilization to reduce spending by $43 billion annually.

• $19BIntegrated pharmacies: Use of Optum Home Delivery and Optum Specialty Pharmacy results in a $19 billion value for clients compared to cash price.
• $4.7BUtilization management: Optum Rx clinically driven prior authorization, step therapy and quantity-level limit management saved plan sponsors $4.7 billion.

• 7%Use of an Optum formulary, compared to an open formulary, resulted in 7% savings per member.
• $450MFraud, waste and abuse solutions generated $450 million in savings through monitoring and corrective action in 2023.

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