Optum Rx — one of the top three PBMs in the United States — said it will shift to a reimbursement model that will pay pharmacies outside its pharmacy network an amount equal to the acquisition cost for a drug along with, in some cases, a dispensing fee.

Optum Rx hopes to move employers and health plans to the new system by Jan. 1, 2028.

The PBM also announced that it will make the pharmacy experience simpler for consumers with chronic conditions by eliminating up to 25% of the prior authorization reviews it now requires for patients who are refilling prescriptions.

The PBM will start by eliminating reauthorization reviews for about 80 drugs.

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Andi Dolan of Traverse Benefits, a benefits firm in Michigan, suggested the reauthorization change announcement should be good for people covered by Blue Cross Blue Shield of Michigan, which uses Optum Rx to manage its prescription benefits.

"Optum Rx is making it easier for Rx consumers to get medications," Dolan said in a LinkedIn post.

The National Community Pharmacists Association said it wants to see details about the reimbursement change proposal.

"We have seen announcements like this in the past by PBMs that claim they want to work with independent pharmacies," the association said. "Based on the results to date, some were obviously intended as political cover or public relations. If this is a good-faith effort, it would be a good first step."

Dr. Cyrus Attia reacted to the reauthorization change announcement with some skepticism.

"I don't want to look a gift horse in the mouth, but what does it say when the second-largest PBM by market share cut their drug prior auth by 25% in less than two months?" Attia asked in a LinkedIn post.

He also wondered about Optum Rx's comment about making it simpler for patients to fill prescriptions.

"Great," Attia said. "But why was it more complex for doctors, pharmacists and patients in the first place?"