OptumRx to Provide PBM Benefits for Point32Health

Point32Health, the not-for-profit health care parent company of Harvard Pilgrim Health Care and Tufts Health Plan, entered into a new, multi-year agreement with OptumRx to provide integrated Pharmacy Benefit Management (PBM) solutions that will enhance services and deliver improved pricing for Harvard Pilgrim and Tufts Health Plan members.

Point32Health, a leading health and wellbeing organization, is the corporate entity of Tufts Health Plan and Harvard Pilgrim Health Care. Point32Health leverages its experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

The new agreement follows the decision earlier this year by Blue Cross Blue Shield of Michigan to choose OptumRx as its new pharmacy benefit provider, ending a relationship with Express Scripts.  On Jan. 1, 2022, Express Scripts will no longer be BCBS of Michigan’s pharmacy benefit provider for commercial individual and group members. BCBS Michigan has approximately 2 million members who have pharmacy benefits in multiple product offerings. 

Effective January 1, 2023, OptumRx’s integrated health and wellness service model will provide pharmacy benefit offerings for Point32Health. OptumRx will support convenient and affordable access to prescription medications to Harvard Pilgrim and Tufts Health Plan members through a comprehensive retail, specialty and home delivery pharmacy network.

Point32Health’s Pharmacy Services Department will continue to manage its prescription drug program, including decisions about which drugs are included in its formularies and the specialty pharmacy program offering.


Takeaway: The new collaboration further broadens the long-term strategic relationships Harvard Pilgrim and Tufts Health Plan have had with OptumRx