The new model is intended to provide pharmacies with better financial means to stock more medicines, which is expected to alleviate drug shortages.
Pharmacy benefit manager Optum Rx will increase reimbursement minimums for brand-name drugs for about 2,300 independent pharmacies around the country – those that are not affiliated with a pharmacy services administrative organization, chain or other entity.
The announcement is an extension of a commitment Optum Rx made in March to update its pharmacy reimbursement model, one that's intended to have pharmacies pay more for brand-name drugs and less for generics.
Optum Rx said at the time that the payment model more closely aligns with the costs pharmacies often face due to "manufacturer pricing actions.”
The change will begin immediately, and full implementation will be achieved by January 2028, Optum Rx said, adding that the move will also make medications more affordable for consumers.
WHAT'S THE IMPACT
While the industry-wide pharmacy model was designed to help promote the use of more affordable generics, Optum Rx said that with generic adoption now quite strong, more high-cost branded drugs are entering the market, raising costs for pharmacies and creating a payment imbalance.
The new reimbursement model is intended to provide pharmacies with better financial means to stock more medicines, which is expected to alleviate drug shortages and improve medication access.
Optum Rx said it was making the investment to improve pharmacies' long-term sustainability, especially community pharmacies that lack large-scale resources.
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