The Thread · The Middleman
Drug Pricing & PBM Markups
A pharmacy benefit manager is supposed to lower drug costs. UnitedHealth's OptumRx — which decides what your plan covers — keeps getting accused of the opposite.
The Documented Record
FTC · 1,000%
UnitedHealth marked up lifesaving drugs as much as 1,000%
Per a Federal Trade Commission report on PBM markups on specialty generics.
Class Action
UnitedHealth accused of overcharging for drugs
A class action over inflated drug costs passed to patients and plans.
FTC · Insulin
FTC sues OptumRx (with CVS Caremark, Express Scripts)
For rebating practices that allegedly inflate insulin list prices and impede cheaper generics.
State AG · Insulin
Arizona sues OptumRx over insulin price inflation
Alleging a scheme with manufacturers to artificially raise diabetes-drug prices.
State AG · Clawbacks
Oklahoma orders OptumRx to halt illegal clawbacks
After OptumRx allegedly overpaid pharmacies, then retroactively clawed the money back.
State Law · Arkansas
OptumRx sued for not notifying independent pharmacies of pricing changes
Reimbursing pharmacies below their costs without their knowledge.
Settlements
OptumRx opioid & workers'-comp settlements
$20M for improperly filling opioid prescriptions; $5.8M over Massachusetts workers'-comp pricing.
WV AG
West Virginia sues OptumRx over the opioid crisis
Alleging the PBM oversupplied pills and obstructed safeguards.
Independent Pharmacy
3,179 pharmacies closed (Jan 2024 – Feb 2025)
More than 5% of U.S. pharmacies, largely from below-cost PBM reimbursement.