How Optum Rx pharmacy benefits better serve you
You need — and expect — pharmacy benefit solutions built around your priorities and supported by clarity, guidance and control. At Optum Rx®, that’s exactly what we do. With us, you can expect:
- An Open Book approach — decisions you can see and trust from the start.
- Aligned scale — buying power and technology investment that work for you.
- Action backed by data and insight — with advanced analytics, artificial intelligence (AI) and expert support.
Together, these commitments create a partnership that doesn’t just perform — it adapts, explains and leads through what’s next.
Smarter benefits with AI and advanced tech
As the leader in advanced technology and the responsible use of AI, we’re supercharging the pharmacy benefit experience and driving meaningful results.
Guiding and designing your pharmacy benefit solutions
You shouldn’t have to choose between what’s best for your employees and your bottom line. We partner with you using data and intelligent technology, clinical expertise and deep industry experience to help guide and design your pharmacy benefits to meet your needs.
Aligned to scale with your pharmacy benefit needs
Our pharmacy benefit solutions are aligned to your priorities, not the other way around. We work towards them, together.
Controlling specialty drug costs
The cost and complexity of specialty drugs requires a solution that provides care without compromise. The outcome is a better experience and lower costs.
Smart tech and AI for faster, safer, lower cost pharmacy benefits
Optum Rx AI and advanced technologies automate work, cut costs and fix issues early. Clients, members and providers get simpler experiences from start to finish.
Open Book: Delivering transparent pharmacy benefits
Transparency is how we operate on a daily basis, from independent clinical decisions to pass-through economics and real-time clarity at the point of care.
Pharmacy Benefit Management for Health Plans
We help health plans customize networks, plan designs and formulary options, redefining quality with our expertise and claims processing technology.
Pharmacy benefits backed by data and insight
We help members, providers and clients act with clarity and confidence — earlier and faster.
Pharmacy Solutions for Workers' Comp and Auto No-Fault
We expertly handle the nuances of workers' comp and auto claims to lower costs, apply our unique clinical expertise, and provide a better experience for you, your staff, and the claimants you support.
What happens when pharmacy benefits are built differently
We're transforming pharmacy benefits to deliver real clarity, real savings and real results.
Delivering better value for our plan sponsors
You know your members best — and we’re here to help you support them. Together, we’ll find the right solutions to ease rising drug costs and improve health outcomes. And we'll tailor them to your plan’s unique pharmacy needs.
What's a pharmacy benefit manager?
Pharmacy benefit managers, or PBMs, help plan sponsors deliver prescription drug benefits to their members. At Optum Rx, we’ve redefined that role with a more transparent model that brings clarity, predictability and alignment to how pharmacy care is priced and delivered. This makes it easier for clients to understand costs.
We connect plan sponsors, pharmacies and pharmaceutical companies while offering clients real-time visibility into pricing and choices. We also support members with digital tools to help manage their prescriptions with confidence. Beyond managing benefits, we provide clinical expertise, cost-management strategies and whole-person support to improve health outcomes.
Pharmacy benefit management FAQ
PBMs provide services to manage prescription drug benefits and improve affordability, access and outcomes. Core services include:
- Negotiating drug prices and managing costs with transparency
- Designing formularies based on clinical evidence, safety and value
- Building pharmacy networks for reliable medication access
- Adjudicating prescription claims accurately based on member benefit design
- Supporting safe, appropriate medication use through clinical programs
- Managing specialty medications for high-cost, complex conditions
- Delivering data insights to help optimize benefit performance
At Optum Rx, Built for You means our pharmacy benefit solutions are designed around your priorities, not a one-size-fits-all model. We align transparency, scale and advanced analytics to your goals so you can navigate change with clarity, confidence and control, today and in the future.
Optum Rx is built on 3 structural advantages that work together:
Rather than asking clients to adapt to our model, we design our capabilities, economics and technology to flex with changing needs and market conditions.
Our transparency commitment gives clients, partners and plan sponsors visibility into how:
- Clinical decisions are made
- Dollars flow
- How performance is measured and verified
We back this commitment with independent clinical governance, audit‑ready access and data that allows clients to validate outcomes and pricing.
Our pharmacy care model fundamentally changes how pharmacy benefits are priced and delivered — replacing traditional approaches tied to drug prices set by manufacturers or prescription volume with a transparent, fee‑based structure.
Scale alone isn’t the advantage. How it’s applied is. Optum Rx directs buying power, technology investment and clinical expertise intentionally to lower costs, simplify operations and improve experiences for clients and members, rather than extracting value through complexity. Start aligning our scale with your pharmacy benefit needs today.
We embed intelligence directly into workflows so insight leads to action at the moments that matter. Advanced analytics, AI and expert support help:
- Surface risks sooner
- Guide decisions in real time and reduce surprises
- Enable our clients to act with confidence in what comes next
Clients experience measurable impact through:
- End-to-end visibility on net cost
- 19% PMPM savings1 when aligned strategies are deployed
- $90+ average member savings with MyScript FinderTM, 1
- Faster administrative decisions with prior authorization approvals under 30 seconds.2
These outcomes reflect how transparency, scale and action work together, not in isolation.
Automation and embedded intelligence remove unnecessary barriers. From faster prior authorization decisions to automated savings at the pharmacy counter, Optum Rx simplifies processes, so clients, providers and members spend less time navigating friction and more time focusing on care.
AI at Optum Rx is used to enhance — not replace — human expertise. We’re laying the groundwork for better pharmacy benefits by:
- Investing $1.5B in AI-related developments
- Deploying more than 1,000 AI solutions
- Certifying over 17,000 AI engineers
Advanced models help detect fraud, anticipate member needs, improve clinical review and streamline communication, with clinicians and service teams always in the loop to ensure accuracy, transparency and trust.
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- Optum Rx analysis. 2025.
- Optum Rx and Surescripts data. April - June 2024.