Rally outside Optum headquarters brings debate over pharmacy benefits managers to Twin Cities

Critics of the pharmacy benefit manager (PBM) industry protested Friday outside the Eden Prairie headquarters of Optum, alleging that business practices by the nation's largest PBMs are driving medication costs up and independent pharmacies out of business.

"People go without services they need, because of their greed," Hoeschen said at a rally across the street from Optum's headquarters with about 50 attendees.

Optum is the health services division of Minnetonka-based UnitedHealth Group, which also owns the giant health insurer UnitedHealthcare. The company's OptumRx division is one of the nation's three largest pharmacy benefit managers, which negotiate drug prices with manufacturers and structure medication benefits within health plans.

In a statement, OptumRx said it has been working to ensure pharmacies are paid fairly while also offering to help them operate more efficiently. The company said it's partnering with pharmacists to provide reimbursement for all the services they provide, including managing patient medications and connecting people with help for basic needs such as food, nutrition and transportation.

An ongoing Federal Trade Commission study published in July found evidence to suggest PBMs may have inflated drug costs and squeezed independent pharmacies while enriching some of the largest companies in the country.

In June, Minnesota Attorney General Keith Ellison led a bipartisan group of 32 attorneys general asking the U.S. Supreme Court to review a case and thereby protect relatively new state regulation of pharmacy benefit managers. Last year, two large public sector employer groups in Minnesota followed the example of a few other states in trying reverse auction technology to address what some see as competition and transparency flaws in awarding PBM contracts.

On Friday, OptumRx pointed to data from the Pharmaceutical Care Management Association — the trade group for PBMs — showing the number of independent pharmacies in the U.S. has increased by 5.8% from 2014 to 2024 .

But state Sen. Glenn Gruenhagen, R-Glencoe, said during the rally that the number of independent pharmacies in Minnesota has dropped from 550 in 1996 to just 156 last year. Gruenhagen said his district west of the Twin Cities lost three independent pharmacies in the past few years.

The event, which drew participants from Minnesota and other states, was organized by three advocacy groups including Arizona-based Pharmacists United for Truth & Transparency. Before the rally, about 50 protesters marched on sidewalks at the perimeter of Optum's campus including Deborah Keaveny, an independent pharmacist in Winsted.

Part of the concern with PBMs, Keaveny said, is they set copays and dispensing rules in ways that effectively steer patients and their prescriptions away from independents and toward mail-order and specialty pharmacies owned by the big companies themselves. In addition, she said PBM reimbursements are below pharmacies' costs.

Just as OptumRx is part of UnitedHealth Group, the big PBMs Caremark and Express Scripts, respectively, are part of giant, vertically integrated companies — Rhode Island-based CVS Health and Connecticut-based Cigna.

"This is an unnecessary layer in the middle that's just sucking money out of our health care system and absolutely destroying access to care," he said in an interview.

In its statement Friday, OptumRx said the company is "removing retroactive recoupment ('clawbacks') for pharmacies" and "offering predictive analytics and reconciliation tools to further reduce administrative burden and allow more time to focus on patient care."