Originally published on Feb 16, 2017
A Florida pharmacy disclosed to the Five Rivers team on February 15, 2017 that OptumRX is now enforcing their sourcing policy.
Although the requirement has been in place since October 1, 2016 it was questionable whether or not Optum would ever enforce the new policy. Association of Independent Pharmaceutical Wholesalers, Inc. filed a legal complaint last year against OptumRX arguing that OptumRX is effectively acting as an agent of the government and creating law with the policy – an illegal action that needs to be reversed. The lawsuit seems not to have deterred OptumRX in the slightest as OptumRX remains fully committed to implementing and enforcing their policy. If pharmacies don’t comply, they are at risk of being denied reimbursements, paying chargebacks and losing their OptumRX network contract.
This isn’t the first time a PBM has been the center of controversy. Over the last few years, numerous lawsuits across the country have popped up from pharmacies and distributors alike, claiming unfair practices that cause irreparable harm to small businesses. Once the businesses are damaged or closed, OptumRX is capable of swooping in to collect prescription volume for their mail-order pharmacy.
Is it time to accept the new “rules of the game” in the industry and admit defeat against the billion dollar juggernauts? What do you think? Please comment below.

About Five Rivers RX

Five Rivers RX is a leading pharmaceutical compliance services firm that uses experience, relationships and knowledge to develop custom solutions for their clients. The company provides numerous services including VAWD Accreditation, state Board licensing and federal registration. Five Rivers helps third-party logistic firms, distributors and manufacturers in the pharmaceutical industry focus on their supply chain while reducing costs, enhancing efficiency and improving quality. Five Rivers is committed to helping their clients thrive and to providing peace of mind.

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