OptumRX unveils rural pharmacy programs amid PBM crackdown

OptumRx launched initiatives designed to expand the services available at community and rural pharmacies amid a looming legislative crackdown on pharmacy benefit managers’ business practices. 

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

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OptumRx said it will roll out a separate program promoting local pharmacies’ preventative care services for pregnant women beginning in July, followed in the fall by a program connecting individuals living in underserved areas with healthcare services at community pharmacies.

The company’s announcement follows one by Express Scripts last month, which promoted a “transparent,” pass-through payment plan for employers and said it was boosting pay to independent rural pharmacies.

In a news release, OptumRx said the initiatives are aimed at bridging health 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 it hoped to serve or its financial investment.

OptumRx declined to make an executive available for an interview.

The programs follow initiatives by OptumRx to increase drug price transparency for customers, and as lawmakers debate a number of PBM industry reforms. 

A House committee last week advanced a bill that would require PBMs to provide details to employers about the prices paid for drugs, among other provisions. Also, a Senate committee earlier this month voted to pass a bill that would ban PBMs’ use of spread pricing and compel companies to pass through all rebates received from drugmakers, both of which lawmakers blame for contributing to rising drug costs. Spread pricing occurs when PBMs charge payers more than they reimburse pharmacies for a drug and keep the difference.

Last week, the Federal Trade Commission widened an investigation of OptumRx and other PBMs’ business practices to include group purchasing organizations, which negotiate rebates on behalf of PBMs. 

The three largest PBMs are affiliated with insurers following years of industry consolidation. OptumRx is the third-largest PBM by market share, responsible for processing 22% of prescription claims in 2022, according to data from Drug Channels, a research firm. CVS Health Caremark controls 33% of the market while Cigna’s Express Scripts holds 24% of the market. 

PBM lobbying group Pharmaceutical Care Management Association launched a seven-figure ad campaign Tuesday blaming drug manufacturers for rising prescription prices. Insurance lobbying group AHIP launched a similar, seven-figure ad campaign last month faulting drugmakers for high drug costs.