UnitedHealthcare eliminating out-of-pocket costs for insulin, other drugs

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On the heels of a strong financial quarter in Q2, UnitedHealthcare has said it will eliminate out-of-pocket costs for insulin and other medications for eligible members, offering a zero cost share for five drugs in its fully insured group plans.

Pending regulatory approval, this could take effect as soon as January 1, 2023.

UHC framed the move as a push to reduce the burden of medical costs for consumers, and to encourage better medication adherence, reducing the risk of complications and expensive hospitalizations. 

UnitedHealthcare and OptumRx, both subsidiaries of UnitedHealth Group, had previously offered point-of-sale discounts for select drugs. Brian Thompson, CEO of UnitedHealthcare, said high prices represent a significant barrier to prescription drugs for many of its members.

"We are doing what we can to shield people from the prices set by pharmaceutical companies, and hope all stakeholders also will act to make prescription drugs more affordable," he said.

WHAT'S THE IMPACT?

In addition to insulin, four preferred emergency use medications will be included in the new standard offering and will also have a zero cost share.

They include epinephrine, which treats severe allergic reactions; glucagon, which treats hypoglycemia; naloxone, which can be used to treat opioid overdoses; and albuterol, which treats acute asthma attacks.

UnitedHealthcare's revenues grew $6.6 billion year-over-year to $62.1 billion, a 12% jump, according to recent financial disclosures. Operating earnings were $3.9 billion, compared to $3.1 billion last year, while total people served grew by more than 600,000, which UHG said was due to community-based and senior offerings. 

The number of people served with domestic commercial benefit offerings has grown by more than 250,000 over the past year, including 80,000 in the second quarter.

THE LARGER TREND

President Biden brought up the topic of insulin prices during his State of the Union address earlier this year, saying it costs about $10 a vial to produce, but typically costs 30 times that amount. 

Biden highlighted insulin prices while calling on Congress to allow Medicare to negotiate drug prices.

In an attempt to make diabetes treatment more affordable, California Governor Gavin Newsom said in a recent Twitter video that the state will begin making its own low-cost insulin, using a $100 million budget to kick-start development and manufacturing of the drug.

The move follows up on his 2019 executive order, issued on his first day in office, that tasked the state's Department of Health Care Services to investigate how California would mitigate the high costs of prescription drugs.

Newsom said in his online address that the high cost of insulin epitomizes market failures, and puts the medication out-of-reach for many who need it.

There are several legislative proposals in Congress, some stalled and some nascent, that would propose a $35-per-month cap on what insured Americans would pay out-of-pocket for insulin – and this cap in costs would benefit about 25% of those on individual and small group markets and about 20% of those in larger employer-sponsored plans.

That's according to a March analysis from the Kaiser Family Foundation, which comes as congressional Democrats are renewing the push for a $35 insulin cap that was included in the stalled Build Back Better Act. That legislation passed the House but became mired in the Senate.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com