Beyond rebates: A new era of transparency
How Optum Rx's transparent pharmacy care model and UnitedHealthcare Pharmacy's integrated benefits are reinventing pharmacy costs and prior authorization.
- Affordability and transparency concerns are at record highs, with 59% of U.S. adults worried about affording prescriptions1 and nearly half unsure where to find reliable drug cost information3
- Optum Rx's new transparent model offers full fee disclosure, predictable fee-based pricing independent of drug costs, and digital tools that give consumers upfront pricing before they fill a prescription
- UnitedHealthcare Pharmacy extends transparency through integrated benefits — visible pricing, rebate pass-through, flexible fee structures and clinical governance — giving employers flexible options and clear criteria for evaluating a pharmacy benefit
Worry about affording prescription drugs has reached its highest level since KFF first polled the question in 2018, with 59% of U.S. adults now saying they are at least somewhat worried about being able to afford prescriptions for themselves and their families.1 Plus, 2 in 5 adults report taking measures such as skipping doses, not filling prescriptions, or other steps because of cost.2
The transparency gap is just as wide:
- Nearly half of patients said they don't know where to turn for reliable prescription cost information3
- 36% said that getting clearer cost information before picking up a prescription would make navigating those costs easier3
- Nearly 84% want their providers to automatically select lower-cost options when clinically appropriate4
For employers, who sponsor coverage for more than half of Americans, this is more than a sentiment problem. When the people they cover can't see or predict their pharmacy costs, they may delay care, skip medications and arrive at the next enrollment cycle less healthy and more frustrated. The call for transparency is really a call for a system that is easier to understand, trust and navigate.
UnitedHealth Group is answering that call through its businesses, Optum and UnitedHealthcare, which are moving toward a pharmacy model that is built on simpler pricing, clearer visibility and stronger alignment.
Optum Rx recently announced a transparent pharmacy care model that fundamentally reshapes how pharmacy benefits are priced and delivered through 3 defining shifts:
- End-to-end fee visibility with full disclosure of manufacturer payments
- A simpler, predictable monthly fee-based pricing structure independent of drug list prices or prescription volume
- Digital affordability tools like Shop MyScript that give consumers upfront visibility into pricing and options before filling a prescription
| Industry norm | Optum Rx transparent model | |
| Pricing tied to list prices, volume and rebates | → | Pricing independent from drug costs |
| Partial or selective transparency | → | Complete fee disclosure from all components |
| Fragmented consumer experience | → | Integrated digital tools at point of care |
As Jon Mahrt, CEO of Optum Rx and chief growth officer for Optum, put it: "This is about trust and alignment. When pricing is detached from drug costs and volume, every decision we make is focused on what matters most — affordability, access and outcomes for the people we serve."
What UnitedHealthcare Pharmacy clients already have built in
While Optum Rx's new model highlights the growing importance of transparency in pharmacy benefits, UnitedHealthcare Pharmacy extends that transparency through an integrated approach that connects decisions, cost and experience so pharmacy works better for everyone.
UnitedHealthcare Pharmacy is delivering on those same priorities through integrated benefits, clinically grounded cost management, and transparent pricing and plan administration options. It brings that to life through:
- Market-based, visible pricing
- Rebate pass-through options
- Flexible administrative fee structures
- Enhanced reporting
- Clinical governance
- Clear cost and coverage information for members and providers
Ensuring clarity on pharmacy costs and decisions
Built on clear pricing, open clinical governance and verifiable reporting, transparency with UnitedHealthcare Pharmacy is designed to support better decisions, stronger trust and a simpler, more predictable pharmacy experience — for employers, employees and providers alike.
For clients evaluating new pricing approaches, UnitedHealthcare Pharmacy offers fee-based administrative pricing options today. Clients can continue to choose the structure that best aligns with their needs, including existing pricing models or a fee-based approach. The point is not to force one model on every employer. It is to give clients clearer options, better visibility and the flexibility to select the financial structure that supports their broader pharmacy strategy.
Ensuring medications and treatments covered under pharmacy benefits are safe and evidence-based is also critical, but it can also add a layer of complexity. As part of broader enhancements to its pharmacy model and beyond, UnitedHealthcare has been and will continue to be committed to evaluating instances in which prior authorization processes can be streamlined, standardized and modernized.
UnitedHealthcare recently launched a new site dedicated to its pharmacy prior authorization process, including approval rates, response times and clinical standards, which can help members understand the data and learn how decisions are made.
What employers should look for
As demand for clearer pharmacy costs rise, employers should evaluate whether a pharmacy benefit is built with clinical integrity and integrated data that can enable better cross-benefit drug management for lower costs and simpler experiences for members and providers.
Questions worth asking:
- Does the pricing model provide clear visibility into fees, rebates and total cost drivers?
- Does the pharmacy strategy connect medical and pharmacy data to support earlier action and better cross-benefit drug management?
- How does the model help members understand cost and coverage before or at the point of care?
- Are clinical decisions grounded in evidence and supported by transparent governance?
- Does the strategy help manage total cost of care, not just pharmacy unit price?
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