Pharmacy benefit management at Optum

Optum pharmacy benefit management (PBM) is laser-focused on doing the right thing. This intensity has sparked innovations that increase cost control by decreasing the personal impact of an injury. Our services:

  • Make filling a prescription easier through a directly-contracted network that includes nearly all of the nation's pharmacies
  • Capture more prescriptions "in-network", achieving up to 98% retail network penetration and reducing your administrative burden in the process
  • Ensure the injured person receives the right medication at the right time
  • Mitigate potential high-risk, high-cost situations
  • Are backed by 24/7/365 service and accessible, hands-on leadership

We built our carefully crafted, deliberately synchronized program on a strong foundation: a fully redundant, secure technology and service platform. On top of this, we overlay injury-specific ​medication ​plans and formularies, drug utilization review criteria, and client-specific business rules. These criteria feed our proprietary electronic adjudication platform, keeping data and communication flowing between pharmacy to payer; lighting the way forward to better outcomes.

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Service Info

  • Network Access

  • Analytics and Informatics

  • Clinical Services

  • Exceptional Service