PHARMACIST STEVE

OptumRx has faced multiple legal actions and regulatory scrutiny from various state pharmacy boards and government entities:

• Mississippi Board of Pharmacy: In 2024, the Mississippi Board of Pharmacy completed an audit of OptumRx’s 2022 claims, alleging the company violated state law by reimbursing its affiliated and chain pharmacies at higher rates than independent pharmacies for the same services. Mississippi law prohibits such practices. The Board released audit findings and scheduled administrative hearings that could lead to disciplinary action, including fines. OptumRx responded by suing the Board, claiming due process violations because of how the findings were publicized before administrative proceedings had concluded. A separate class-action lawsuit from Valley Drugs, Inc. also cites the board’s audit as evidence1234.

• California Board of Pharmacy: The California Board of Pharmacy has taken disciplinary actions against OptumRx several times. In 2022, the Board fined OptumRx $100,000 and placed one of its pharmacies on probation for a year due to issues such as prescription refill failures, inappropriate substitution of medicines, and dispensing errors occurring between 2016 and 2020. The Board had previously issued citations for similar violations in 2013–2014. OptumRx was also required to make a $75,000 donation to charity and comply with additional disciplinary terms, including implementing community service programs and cost reimbursement to the board567.

• Kentucky Opioid Litigation: In November 2024, the Kentucky Attorney General added OptumRx to a lawsuit concerning the opioid epidemic. The state alleges that OptumRx, as a pharmacy benefit manager, contributed to the reckless distribution and oversupply of opioids through non-transparent and profit-driven business practices8910.

• Other Legal Disputes: OptumRx has occasionally been implicated in lawsuits relating to pharmacy board procedures, such as cases where accreditation applications were denied or where network restrictions affected wholesalers. However, some federal courts have declined to find the National Association of Boards of Pharmacy or related entities as “state actors,” thus limiting suits under federal civil rights laws111213.

These cases highlight OptumRx’s recurring regulatory challenges with both state pharmacy boards and attorneys general, particularly around reimbursement rates, patient safety, and controlled substance dispensing. Disciplinary orders and settlements typically include fines, probation, or required corporate reforms. The company has actively contested some of these actions in court while also negotiating settlements in others.

UnitedHealth Group stands at the very top in the insurance, pharmacy benefit manager (PBM), and mail order prescription (Rx) space when measured by gross annual revenue. For 2024, UnitedHealth Group reported total revenues of approximately $400.3billion, solidifying its position as the highest-grossing healthcare company in the United States by a wide margin12345. This revenue spans its combined health insurance (UnitedHealthcare) and its Optum segment, which includes its massive PBM business (OptumRx).

Within the PBM/mail order segment:

• OptumRx, UnitedHealth’s PBM arm, generated about $133.2billion in gross revenue for 2024, marking a 14.8% growth year-over-year67.

• OptumRx is the third-largest PBM in the country by claims volume, trailing only Cigna’s Express Scripts and CVS Caremark, but it is the largest by parent company gross revenue891011.

For comparison, here is how UnitedHealth/OptumRx stacks up with primary competitors in annual revenue (2024 estimates):

UnitedHealth’s dominance is thus clear both in the scale of its overall business and in the core PBM/mail-order field13467.