Optum Rx updates reimbursements for community pharmacies

December 18, 2025 | 2-minute read

This is the latest effort from Optum Rx to better support the important role of community pharmacies. With this addition, 100% of community and independent pharmacies in the Optum Rx network have transitioned to the new reimbursement model.

With this change, community pharmacies will have more transparency and financial predictability to manage costs as brand-name drug prices and usage increases.

Breaking it down

In 2023, drug companies launched new U.S. drugs at prices 35% higher than the previous year. Across brand drugs, manufacturers have set list prices in the U.S. 422% higher than in other nations.

Pharmacies buy the medications they dispense to patients. After a patient gets their prescription, the pharmacy is paid back for the dispensed medication.

A long-established, industrywide system successfully encouraged the use of lower-cost generic drugs, and now generics are common. However, there is an increase in the use of expensive brand-name drugs that is significantly increasing costs for pharmacies. To help pharmacies adapt, the new reimbursement model is designed to better match the rising costs controlled by drug manufacturers. The financial predictability offered through the new model will allow pharmacies to stock more medications and make it easier for people to get the prescriptions they need.