Beginning Jan. 1, 2024, Optum Rx will place eight preferred insulin products on tier one of standard commercial formularies, limiting out-of-pocket spend to $35 or less.
Optum Rx, a pharmacy services company, today announced additional actions to make insulin more affordable, moving several rapid-, short- and long-acting insulins to tier one, which offers the lowest cash price consumers pay. This is the latest effort by Optum Rx to ensure consumers have access to affordable medications and are protected from the high prices set by drug manufacturers.
In all, Optum Rx will shift eight products, including all short- and rapid-acting insulins, to tier one, or “preferred” status on standard formularies. Three manufacturers will have products added to tier one, including Eli Lilly, Novo Nordisk and Sanofi.
In 2022, the company supported UnitedHealthcare in its work to eliminate copays for consumers in group fully insured plans for insulin and other critical drugs used to treat emergencies such as severe allergic reactions, hypoglycemia, opioid overdoses and acute asthma attacks. In total, 170 unique medications are part of the Optum Rx Critical Drug Affordability program that includes a recommended cost share of $35 or less for consumers.
Today more than 70% of people who use Optum Rx already pay less than $35 per month on insulin. Effective Jan. 1, 2024, thanks to the latest actions by Optum Rx, 98% of all Optum Rx consumers will have access to insulin for $35 or less per month.
“I’ve seen firsthand how high prices for insulin and other necessary medications can cause patients to limit or skip doses,” said Dr. Patrick Conway, chief executive officer of Optum Rx. “Medicine that people can’t afford is useless, and by taking this important next step to change our formulary, we will lower costs and improve access for more people who need this life-saving medication. Our goal is to make all essential medicines affordable.”
Drug manufacturers have the sole discretion over setting and raising prescription drug prices. Pharmacy benefit managers, including Optum Rx, serve as the counterweight to the manufacturers and are the only player in the prescription drug supply chain actively working to lower drug costs. This formulary decision builds on a series of Optum Rx actions to help protect consumers from high and rising drug prices and provide them with more choices.
Last January, Optum Rx launched Price Edge, a consumer solution that seamlessly compares available direct-to-consumer pricing for traditional generic drugs with insurance pricing to ensure people who use Optum Rx always get the lowest available prescription drug price. Optum Rx will continue to roll out products, services and policy initiatives to make medications more affordable and provide consumers more information to make decisions on their health care.
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