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 its 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.