August 29, 2016 6:32 AM ET

Healthcare Providers and Services

Company Overview of OptumRx, Inc.

Company Overview

OptumRx, Inc., a pharmacy benefit management company, manages prescription drug benefits of commercial, Medicare, and other governmental health plans, as well as those of employers and unions in the United States. It operates a network of community pharmacies in the United States, as well as mail service pharmacies in California and Kansas. The company also specializes in the delivery, clinical management, and affordability of prescription medications and consumer health products; and offers specialty pharmacy and mail service, clinical programs, and tools and strategies. In addition, it offers medical supplies to Medicare advantage; and sells medical products online. OptumRx, Inc. was forme...

2300 Main Street

Irvine, CA 92614

United States

Founded in 1989





Key Executives for OptumRx, Inc.

Chief Executive Officer
Age: 56
Chief Financial Officer
Age: 45
Chief Operating Officer
Age: 44
Chief Executive Officer of Optum
Age: 62
Compensation as of Fiscal Year 2016.

OptumRx, Inc. Key Developments

The California Public Employees' Retirement System Selects OptumRx, Inc. as New Pharmacy Benefits Manager

The California Public Employees' Retirement System, or CalPERS, has selected OptumRx, Inc., as its new pharmacy benefits manager, or PBM. The company will administer prescription drug benefits for nearly 486,000 members and their dependents enrolled in all of CalPERS' health plans with the exception of the Kaiser and Blue Shield of California Health Maintenance Organization (HMO) plans. The five-year contract - worth an estimated $4.9 billion - takes effect January 1, 2017, and ends December 31, 2021. It will cover pharmacy benefits for members enrolled in CalPERS' self-funded PERS Select, PERS Choice, and PERSCare Preferred Provider Organization health plans, as well as for those enrolled in the Anthem Blue Cross, HealthNet, Sharp, and UnitedHealthcare HMO plans. OptumRx, a subsidiary of UnitedHealth Group, is headquartered in Eden Prairie, Minnesota, and has connections to more than 67,000 pharmacies nationwide. It will replace CalPERS' current PBM, CVS Caremark, whose contract expires December 31, 2016. CVS has held the PBM contract since January 1, 2012. OptumRx was one of three finalists in a competitive bid process for the PBM contract. In addition to CVS, the other bidder was Express Scripts, Inc. The CalPERS Board of Administration awarded the PBM contract to OptumRx based on the results of its final bid submission. Contract terms require that the PBM provide drugs of the quality and value, based on sound clinical evidence. It also requires transparency and full disclosure of the financial relationships between the PBM and drug manufacturers. All of the bidders for the PBM contract were evaluated on their strategies for price controls, sustained affordability, pricing, innovation, mail order networks, formularies, drug utilization programs, utilization management, and customer service.

OptumRx and Walgreens Partner to Create New Pharmacy Solution

OptumRx, Inc. and The Walgreen Company have partnered to create a new pharmacy solution to meet consumers' changing prescription drug needs and help employers, health plans and their members achieve better health outcomes and greater cost savings. Through a more convenient, accessible and connected pharmacy experience, the companies will collaborate to deliver clients and members enrolled in the program an integrated pharmacy care offering that provides eligible OptumRx members the option to fill 90-day prescriptions at home delivery copay levels at any of Walgreens nearly 8,200 pharmacies nationwide or through OptumRx home delivery. The integrated pharmacy care offering produces higher treatment adherence rates and better patient outcomes by giving patients the choice of how to receive their medications along with 24/7 pharmacist availability; and connects members to clinical guidance that addresses specific disease classes, such as diabetes, and increases drug adherence. The integrated pharmacy care offering enables OptumRx and Walgreens systems to better connect and communicate health data and analytics to ensure members receive the most effective prescription drugs at the right cost. The joint pharmacy care offering is also designed to meet the goals of payers and health care sponsors seeking to better manage drug benefits and address the rising cost of care. By providing members with the choice of how to fill their 90-day maintenance medications, Walgreens and OptumRx can offer better access and prescription drug cost management to clients to help improve adherence rates for eligible members, resulting in better health outcomes and total health care cost savings. OptumRx and Walgreens expect the new pharmacy solution to be available to commercial clients implementing new 90-day prescription benefit designs, beginning January 1, 2017.

Kessler Topaz Meltzer & Check, LLP And Cooper & Kirk, PLLC File Class Action Lawsuit Against UnitedHealth Group Inc., UnitedHealthCare, Inc., UnitedHealthcare Life Insurance Co., Optum, Inc. and OptumRx, Inc. for their Refusal to Cover Medically Necessary Treatment

The law firms of Kessler Topaz Meltzer & Check, LLP and Cooper & Kirk, PLLC have filed a class action lawsuit in the United States District Court for the District of Minnesota against UnitedHealth Group Inc., UnitedHealthCare, Inc., UnitedHealthcare Life Insurance Co., Optum, Inc. and OptumRx, Inc. for their unlawful denial of coverage and refusal to pay for Harvoni­ – a medically necessary treatment which can effectively cure chronic Hepatitis C. Hepatitis C is a contagious blood-borne virus that attacks the liver and affects millions of people in the United States. The chronic form of Hepatitis C leads to a host of medical problems. The U.S. Food and Drug Administration approved Harvoni exclusively for the treatment of genotype 1 CHC patients in October of 2014, calling it a "breakthrough" drug. Harvoni is the first drug approved for the treatment of CHC that does not require combination with other drugs, and can effectively cure CHC in 94% to 100% of cases with little to no side effects. Notwithstanding the life-saving treatment offered to CHC patients by Harvoni, Defendants have unlawfully limited Plaintiff's and class members' access to this miracle drug by developing arbitrary coverage criteria. As detailed in the complaint, Plaintiff and class members were diagnosed with Hepatitis C, prescribed Harvoni by their physicians, and unlawfully denied coverage of Harvoni by the Defendants. As a result, Plaintiff and class members have been and continue to be irreparably damaged by Defendants' denial of coverage for their medically necessary Harvoni treatment.

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