NB: This write-up focuses only on Optum Rx and the PBM segment and does not discuss Optum Insights or Optum Health.
HTN’s View: While we’re still watching the margins of the Big 3 PBMs as they navigate the transition to transparent models as well as potential competitive pressure from disruptive challengers, Optum Rx Q3 results underscored the durability of the combined PBM and specialty pharmacy model: specialty volume up 2.6% while total adjusted scripts fell 5%, keeping revenue approximately flat while growing operating earnings 11%. Covered lives and script growth matter, but mix, scale, and operational excellence matter more.
Optum Rx Q3 results show YoY adjusted scripts down, revenue basically flat, and operating earnings up.
Revenue increased slightly to $39.9 billion from $39.7 billion, while operating earnings rose to $1.7 billion from $1.5 billion. Operating margin improved 40 basis points, to 4.3% from 3.9%; UnitedHealth attributed the earnings improvement to biosimilar adoption and operational improvements.
Members outside UnitedHealthcare now account for more than 50% of Optum Rx's covered lives.
For the first time, more than half of Optum Rx’s covered lives were outside UnitedHealthcare, suggesting a diversifying customer base. Still, the company did not quantify how much the shift reflected new external business versus declines in UHC membership.
2027 selling season going as expected, with wins and retention setting up 2027 for a further rebound
Jon Mahrt said Optum Rx was winning new clients, retaining clients at a rate in the high 90s this year, and expected external membership growth to continue into 2027.
