Optum Rx, the pharmacy benefit manager (PBM) of UnitedHealth Group, will launch a new drug-pricing model “that combines guarantees into a single member cost, [and] will offer drug benefit plan sponsors greater predictability of pharmacy spend to help manage total lowest net cost.”
The new Optum Rx Clear Trend Guarantee will be available starting Jan. 1, 2025, Optum Rx said in a May 20 announcement. Clear Trend Guarantee will be an alternative to the current Optum Rx Cost Made Clear system.
In the announcement, Optum Rx said Clear Trend Guarantee is a “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.”
“It is more important now than ever before to be an innovator in health care and to drive affordability and value for plan sponsors and members,” said Optum Rx CEO Patrick Conway. “We are not stopping with Clear Trend Guarantee, and will continue to deliver clear information, transparent and lowest net cost, choice and a simplified pharmacy benefit for everyone.”
Pharmacists continue to express concerns over PBMs and funding, including that reimbursement amounts from some PBMs are lower than what the pharmacies pay to purchase the medications.
