May 20 (Reuters) - UnitedHealth ( UNH ) said on Monday
its unit OptumRx would offer a new pricing model, starting next
year, to help manage insurers' costs for drugs.
The new model, Optum Rx Clear Trend Guarantee, will provide
value-based pricing of drugs per member combining the cost of
these medicines from various sources such as retail pharmacy,
home delivery, specialty drug and rebates.
Under value-based pricing models, insurers, pharmaceutical
companies and the middlemen, which include pharmacy benefit
managers (PBMs) like OptumRx, agree to link payment for medicine
to the overall outcome for patients.
The new model adds to OptumRx's announcements of other
measures to offer transparent pricing of drugs last year and
comes amid increased scrutiny into the role of PBMs in
ballooning healthcare costs in the United States.
Currently, out-of-pocket drug prices are decided by a
complex, multi-tiered network including insurers, drugmakers,
pharmacies and PBMs, resulting in ambiguity around fees and
markups to the original cost of the drug.
PBMs handle prescription drug benefits for health insurance
companies, large employers and Medicare prescription drug plans
- a group often referred to as payers.
OptumRx's new model will be effective at the same time as
TrueCost, which was announced by CVS' PBM unit, Caremark, to
offer clients more visibility into prescription drug pricing and
administrative fees.