Optum is changing the way it pays pharmacies
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OptumRx is changing the way it pays pharmacies, reimbursing them more for branded drugs and less for generics, the company announced.
Why it matters: Drug supply middlemen like Optum are facing more criticism for using anticompetitive tactics that steer business to their own affiliates and can disadvantage independent pharmacies.
The big picture: This is the third change to its business practices that Optum has announced recently, aimed at addressing yet another common pharmacy benefit manager frustration.
- But it hasn't just been patients and pharmacies raising concerns. PBMs are also in lawmakers' crosshairs.
- Just this month, a bipartisan group of senators introduced yet another PBM bill. This one would block the practice of reducing or clawing back drug reimbursements to pharmacies and require Medicaid payments to PBMs to be passed directly to pharmacies, Axios Pro reported.
- Others have proposed prohibiting the parent company of a PBM or insurer from owning pharmacies.
- A major Federal Trade Commission report released last year accused PBMs of "squeezing Main Street pharmacies" in its title.
Between the lines: Although large PBMs have been accused of underpaying pharmacies, they've also been accused of business practices that inflate the cost of generics.
- Optum said its payment changes, which are effective immediately and will be fully implemented by 2028, address "a legacy, industry-wide model that was originally designed to help promote the use of affordable generics," and the new models will align "more closely to the costs pharmacies may face due to manufacturer pricing actions."
- "This move will help correct imbalances in how pharmacies are paid for brand and generic drugs and will ensure greater access to medicines for patients across the country," OptumRx CEO Patrick Conway said in a statement.
- Overall pharmacy reimbursement rates won't change, the company said, but addressing the imbalance will help pharmacies stock more medicines and alleviate drug shortages.
