Optum Rx deepens support for independent pharmacies with a focus on better health outcomes, enhanced access in rural areas

Today, millions of Americans live miles away from access to their essential medications, while skyrocketing drug prices, set by manufacturers, are squeezing reimbursement pharmacists receive when dispensing a drug. Low-income communities disproportionately lack access to pharmacies due to transportation barriers, systemic inequalities and distance. As a result, individuals in these communities have a harder time adhering to medication schedules and experience wider health disparities.

For pharmacies in rural and underserved communities and the people they serve, Optum Rx is deepening its commitment to support their critical role in care by launching new programs, expanding existing initiatives and launching a new pharmacy network option for customers.

By the numbers:

Urban pharmacy deserts are those with an average distance of 1 mile to the pharmacy. In low-income areas with low vehicle ownership, pharmacy deserts are those with an average distance is 0.5 miles to the pharmacy.

Meaningful pharmacist support with a focus on better health outcomes

Optum Rx remains committed to supporting independent pharmacies and the communities and people they serve. In fact, Optum Rx reimburses independent pharmacies in rural areas more than retail chain pharmacies and all affiliated pharmacies by 2-3% of average wholesale price. We have also eliminated all clawbacks and DIR fees and have no plans to reinstate them.

Building on our existing support for independent pharmacies, these initiatives and options will address core pain points cited by pharmacies, including drug dispensing reimbursement and limited resources supporting social drivers of health in pharmacy deserts. Notably:

• The Independent Pharmacy Network (IPN) will be available to clients as an add-on to their current pharmacy network options and will provide community and independent pharmacies with increased reimbursement on generic (5%) and brand (.2%) drugs.
• Optum Rx is expanding the Bridge to Healthy Baby program to more markets and supplementing the expansion to include diaper and maternity dry goods initiatives in underserved populations. Bridge to Healthy Baby provides pregnant moms with a baby kit that includes maternal fetal care and baby products, as well as a wallet card to the National Maternal Mental Health Hotline to support a healthier pregnancy and help prevent birth defects and pre-term labor. To provide additional support in expanded markets, Optum Rx will donate $25,000 to diaper banks in five new Bridge to Healthy Baby markets.
• Launched this year, Bridge to Pharmacy Care connects members to transportation resources to and from the pharmacy if a need exists. Pharmacists will be reimbursed for successfully connecting patients to these resources.
• The Bridge to Wellness Program is offered by Optum Rx to help independent pharmacies manage utilization, cost and clinical complexities for members with chronic disease, including diabetes. The program provides extra care management services, including an assessment of current condition, A1c exam, foot exam and assessment of symptoms, prescription and ongoing medication adherence support. The pharmacist will be reimbursed for the additional support and patients will be empowered to manage a chronic health condition and could be directed to lower cost medications.
• In 2025, the Bridge to Provider Care will provide members living in rural or urban areas without access to health care with telemedicine resources that will connect the member to a physician to discuss health issues, free of charge, to promote better health outcomes.

For all of the “Bridge” programs, pharmacists will be reimbursed for successfully connecting patients to needed resources.

Building a healthier future together

Optum Rx is committed to making a lasting impact on the communities we serve. For members in underserved communities, our pharmacy initiatives aim to:

• Improve medication adherence: The Independent Pharmacy Network and “Bridge” programs focus on supporting the impact of pharmacy deserts by addressing medication access and adherence, leading to better health outcomes for patients.
• Reduce health disparities: By focusing on underserved communities, the programs seek to provide access to resources that address equity issues that impact a person’s health care, including reliable transportation to the pharmacy.
• Empower patients: By supporting access to pharmacies and programs that address social drivers of health in pharmacy deserts, the patient has greater control and independence over their health care journey.

Optum Rx already proactively eliminated certain administrative practices and is empowering pharmacies with business solutions that simplify processes, programs that promote predictability and industry-leading enhanced reimbursement.

• Optum Rx offers enhanced pharmacy self-service digital capabilities for more efficient reporting and access to claims and payment data to ease administrative burdens and manage revenue.
• Optum Rx offers predictive analytics and reconciliation tools to further reduce administrative burden and allow more time to focus on patient care.