OptumRx Launches Rural Pharmacy Program Amid PBM Action

OptumRx launched an initiative designed to expand the services available to community and rural pharmacies amid emerging legislative crackdown on the business practices of Pharmacy Benefit Managers.

PBM, which is owned by United Health Group, will work with pharmacies in seven states to connect pregnant women and diabetes patients with housing, transportation and food assistance, the company said Tuesday. OptumRx will rely on community pharmacists to connect members with Unite Us, a software company connecting members in Louisiana, Nebraska, New Jersey, New Mexico, New York, North Carolina and Texas with local resources starting in June. Plans call for the program to expand nationally in the fall.

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optmrx said it will launch a separate program to promote local pharmacies’ preventive care services for pregnant women starting in July, followed by one that will link individuals living in under-served areas with health services at community pharmacies There will be a program.

Company announcements one after the other last month express scriptWhich promoted a “transparent,” pass-through pay plan for employers and said it was raising pay to independent rural pharmacies.

In a news release, OptumRx said the initiative aims to address healthcare disparities for patients living in rural areas or healthcare deserts. The company did not disclose how many pharmacies it anticipated working with, the number of members or its expected financial investments.

OptumRx declined to make an executive available for interviews.

Programs follow initiative by OptumRx Increase transparency in drug prices for customers, and debate a number of PBM industry reforms as lawmakers.

A house committee introduced a bill last week that would require PBMs to provide employers with details about the prices they paid for drugs, among other provisions. In addition, earlier this month a Senate committee voted to pass a bill that would ban PBMs’ use of spread pricing and force the companies to forgo all rebates they receive from drug makers, both lawmakers said. are responsible for contributing to the rising cost of Spread pricing occurs when PBMs charge payers more for a drug than pharmacies reimburse them and keep the difference.

last week, the The Federal Trade Commission widened its investigation into the business practices of OptumRX and other PBMs to include group purchasing organizations, which negotiate rebates on the PBM’s behalf.

The three largest PBMs are affiliated with insurers after years of industry consolidation. OptumRx is the third-largest PBM by market share, accounting for 22% of prescription claims processed in 2022, according to data from Drug Channels, a research firm. cvs health caremark Cigna controls 33% of the market express scripts Holds 24% of the market.

The PBM lobbying group Pharmaceutical Care Management Association on Tuesday launched a seven-figure ad campaign blaming drug makers for rising prescription prices. Insurance lobbying group AHIP launched a similar, seven-figure ad campaign last month that blamed drug makers for high drug costs.

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