Optum Rx has unveiled a new pricing model, the Optum Rx Clear Trend Guarantee, as part of its effort to provide clients with transparent and predictable pharmacy benefit management. This innovative solution is the latest addition to their Cost Made Clear payment options, designed to address the increasing drug costs while meeting the demand for transparency and choice.
Building on the previous Cost Made Clear solutions introduced last year, Optum Rx continues to lead the industry with a variety of strategies that ensure clarity and control over pharmacy spending. The Optum Rx Clear Trend Guarantee™ offers a consolidated per-member cost structure that helps drug benefit plan sponsors achieve better predictability in managing pharmacy expenditures, aiming for the lowest overall net cost.
With U.S. drug spending exceeding $711 billion—up from $493 billion in 2018 and projected to surpass $1 trillion by 2028—the need for transparent and value-driven solutions is critical. Optum Rx, as a leading pharmacy benefit manager (PBM), is responding to these demands by expanding its range of offerings to better meet the financial constraints and expectations of benefit plan sponsors and their members.
The Optum Rx Cost Made Clear solutions available today include pass-through models that provide cost-plus pricing with reduced ingredient costs. The newly introduced Clear Trend Guarantee differs by combining retail, home delivery, specialty drug, and rebate elements into a single per-member cost guarantee.
Unlike other market models that segment these guarantees, Clear Trend Guarantee offers a streamlined approach to pharmacy benefits payments, assisting plan sponsors in effectively managing drug trends and expenditures. This model promises to deliver substantial value to individuals and families by ensuring predictable premiums and drug costs.
Clear Trend Guarantee promotes efficient care through a value-based model with shared savings. It utilizes outcome-focused data at both the member and population levels, targeting disease-specific pathways to enhance care effectiveness.
Starting January 1, 2025, Optum Rx PBM will provide the Clear Trend Guarantee to drug benefit plan sponsors, alongside the complete range of Cost Made Clear payment solutions and the existing traditional and pass-through models.
Key savings statistics associated with Optum Rx include:
$43 billion in rebates: Achieved through volume aggregation and utilization management.
27% network savings: Plan sponsors benefit from a 27% reduction, equivalent to $43 billion, through negotiated Optum Rx network pharmacy rates.
$19 billion from integrated pharmacies: Utilization of Optum Home Delivery and Optum Specialty Pharmacy offers a $19 billion value compared to cash prices.
7% formulary savings: Using an Optum formulary, as opposed to an open formulary, results in a 7% savings per member.
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