Optum Rx Introduces Fee-Based Model; Impact Manageable

Research evidence excerpt

Optum Rx Introduces Fee-Based Model; Impact Manageable

Flash Note Health Care | Healthcare Facilities & Managed Care

May 11, 2026

UnitedHealth Group Inc Elizabeth Anderson Amir Farahani, CFA 212-446-5632 646-551-8518

UNH | $383.93 elizabeth.anderson@evercoreisi.com Amir.Farahani@evercoreisi.com

Outperform | Target Price/Base Case: $400.00 Ayush Vyas Joanna Zhou

Commentary 646-551-8512 212-446-5659

Ayush.Vyas@evercoreISI.com joanna.zhou@evercoreisi.com

UNH announced today that Optum Rx is moving to a fully transparent, fee-based model, replacing pricing tied to manufacturer list

prices or prescription volume with a clearly defined monthly per-member fee, and eliminating spread pricing. Clients will get full

visibility into all Optum Rx fees, including those from its GPO, which will fully transition to flat service fees by end of 2027. The

shift sits alongside Optum Rx's earlier January 2025 commitment to pass through 100% of manufacturer rebates to clients by Jan

1, 2028, cost-based pharmacy reimbursement terms rolled out in March 2025, and brand-drug reimbursement increases for

~2,300 independent pharmacies. UNH also reiterated its long-term target margins for Optum Rx, claiming the new model will not

impact Optum Rx financials.

Our thoughts: This announcement is not surprising as Optum Rx’s peers (namely CVS Caremark and Evernorth) have already

begun their transition to a rebate-free model. We think Optum Rx has been working on this transition for a while, and this

announcement brings its model in line/beyond peers’ (notably with the PMPM fee vs. drug cost + fee and GPO flat fees). In terms

of the financial impact, the announced model is ahead of the previous plan to phase out rebates by end of 2027, and we agree