Optum Rx Launches Transparent PBM Model With New Digital Prescription Pricing Tools

Alongside the pricing model overhaul, Optum Rx introduced two new digital tools, ShopMyScript and Price Wise, focused on providing real-time prescription cost transparency.

Optum Rx has unveiled a new transparent pharmacy benefit management (PBM) model alongside digital tools designed to improve prescription pricing visibility and member decision-making.

The company said the updated PBM structure will move away from traditional pricing models linked to drug manufacturer rebates or prescription volumes and instead adopt a fee-based system with fixed monthly per-member charges.

Alongside the pricing model overhaul, Optum Rx introduced two new digital tools, ShopMyScript and Price Wise, focused on providing real-time prescription cost transparency.

The ShopMyScript platform alerts members as soon as a prescription is submitted and displays pricing details before the medication is filled. The tool also allows users to compare pharmacy pickup and home delivery options in real time.

According to the company, the goal is to help members make earlier and more informed decisions around prescription purchases and reduce prescription abandonment linked to unexpected costs at the pharmacy counter.

The second tool, Price Wise, provides a detailed cost breakdown that includes medication pricing and associated fees. The feature is designed to display the full out-of-pocket cost upfront, including for individuals purchasing medications outside of insurance benefits.

Optum Rx said the tools are intended to simplify navigation of pharmacy pricing and improve visibility into prescription costs for members and employer clients.

The company also announced that it will eliminate spread pricing under the new PBM model. Its group purchasing organization will transition fully to flat service fees by the end of next year.

The launch follows broader changes by Optum Rx to its pharmacy operations, including plans announced in 2025 to pass through 100% of drugmaker rebates by 2028 and efforts to reduce prior authorization requirements.

The announcement comes amid growing industry and regulatory pressure on pharmacy benefit managers to increase transparency around drug pricing and rebate structures. Earlier this year, lawmakers passed PBM reform legislation aimed at tightening oversight of pricing practices across the sector.

Express Scripts had also announced a shift away from rebate-based models last year, signaling broader changes in the PBM market.

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