Optum Rx pharmacy pricing model strives for openness

Optum Rx, the pharmacy services arm of UnitedHealth Group’s Optum, has introduced a new pharmacy model called Clear Trend Guarantee, aimed at increasing transparency around drug costs for members. This price-centered offering promises to provide drug benefit plan sponsors with greater predictability of pharmacy spend to help manage the total lowest net cost.

The Clear Trend Guarantee model includes retail, home delivery, specialty drug, and rebate components all rolled into one per-member guarantee. This ensures plan sponsors have a clear path to a “bottom line” pharmacy benefits payment, supporting effective management of drug trend and spending. Ultimately, this will deliver value to individuals and families seeking more predictability in their healthcare costs.

With current U.S. drug spend exceeding $711 billion and expected to surpass $1 trillion by 2028, Clear Trend Guarantee is a value-based model with shared savings to promote efficient care. It leverages outcome-driven, disease-specific data to identify more effective care pathways for members.

Beginning January 1, 2025, Optum Rx will offer Clear Trend Guarantee alongside a full suite of Cost Made Clear payment offerings and traditional pass-through models. This move comes at a time when Americans pay more for brand-name prescription medications compared to residents of other countries, highlighting the need for innovative solutions to drive affordability and value in healthcare.

Optum Rx CEO Patrick Conway emphasized the importance of innovation in healthcare, stating that the company will continue to deliver clear information, transparent and lowest net cost, choice, and a simplified pharmacy benefit for everyone.