Any knowledge out there about what is happening with OptumRx? Any rumors about the status of the various pharmacy locations? There were stories at the end of December where they lost a significant amount of pharmacy business with CalPers moving to CVS. There were also other scattered stories about various states moving to other options for Medicaid. All that combined with an enrollment decline in ACA plans would seem like a big problem, but here it seems to be mostly Optum Health that is discussed.
10 replies (most recent on top)
@OP My family is forced to use Optum RX since 2025 and I'm not happy with it. Meds I've taken for years and were always approved, are being denied and no help in replacing. So many denials and large out of pocket costs. My husband had a serious throat condition that required a special mouth wash that was awful, but it helped numb his throat for hours of relief...yep, Denied! No other replacement. The meds were very effective for what he was DX'd with, but we had to pay out of pocket for serious costs. Unbelievable and it shouldn't be so hard to help our customers. All the boasting we hear at our Town Halls, and all we get is bad service even as employees.
@e0 the last round from a few weeks ago impacted HD.
OptumRX? FTL. TrumpRX Baby!
@dx Where did these occur?
@ae not true at all - there were layoffs on the RX end many people who's last day was today.
Net profit spread for HDP was normally 3-5%. Specialty was 5%+. Specialty was around 40B in annual revenue so 5% of that was net profit. This was on the pharmacy side only. Insurance for OptumRx PBM would be higher, guessing 10-30%.
My concern is the new legislative focus on Emisar. If the US govt takes away Optum’s offshore GPO as they are rumored to want to do, ORx ability to make money will be severely diminished. Without the GPO, money will buy tight.
Now the new Trump RX is bound to cut into some profits as well. Plus if there’s loss of business there’s less dr-gs. It’s not rocket science whoever made the comment they’re typically safe. That’s not true, less business means cuts.
@OP I think some people from optum rx were included in the 01/23 layoffs if I remember correctly. Otherwise haven’t heard anything other than in the news about PBM changes which might affect optum rx
Rx is typically safe, it's Optum's biggest money maker regardless of loss of business. While none of us is ever "safe", I would say we are safer than some other teams.