Optum Rx moves 8 insulins to 'preferred' status in bid to reduce costs
Once the current strategy is implemented, 98% of all consumers will have access to insulin for $35 per month, company says.
Photo: Guido Mieth/Getty Images
At the start of next year, pharmacy services company Optum Rx will place eight preferred insulin products on Tier One of standard commercial formularies, limiting out-of-pocket spend to $35 or less.
The UnitedHealth Group subsidiary said this action is part of ongoing efforts to improve access and make critical medications more affordable.
The eight products, including all short- and rapid-acting insulins, will be moved to the first tier, or "preferred" status on standard formularies. Three manufacturers will have products added to Tier One, including Eli Lilly, Novo Nordisk and Sanofi.
The company estimates that more than 70% of people who use Optum Rx already pay less than $35 per month on insulin. Once the current strategy is implemented, 98% of all consumers will have access to this price.
In total, 170 unique medications are part of the Optum Rx Critical Drug Affordability program.
WHAT'S THE IMPACT?
In making the announcement, Optum Rx positioned itself as a counterweight to drug manufacturers, who have sole discretion over setting and raising prescription drug prices.
"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," the company said.
Last January, Optum Rx launched Price Edge, a consumer solution that compares available direct-to-consumer pricing for traditional generic drugs with insurance pricing; this, the company said, ensures people who use Optum Rx get the lowest available prescription drug price.
Optum Rx plans to continue rolling out products, services and policy initiatives intended to make medications more affordable, the company said.
THE LARGER TREND
Upon Price Edge's January launch, Optum Rx positioned the tool as an enhancement of the company's ability to offer a lower price on generics at about a 90% rate. Price Edge, the company said, ensures competitive consumer prices on generics by scanning available prices and automatically providing the lowest available pricing to the member. If there is a lower cost to the member outside of their insurance benefit, Price Edge automatically applies that price, Optum said.
In March, the House Oversight Committee launched an investigation into PBM's tactics, which Chairman James Comer (R-KY) said are "harming patient care and increasing costs for consumers."
Comer called on senior officials at the Office of Personnel Management (OPM), Centers for Medicare and Medicaid Services and the Defense Health Agency (DHA) for documents and communications to determine the extent to which PBMs' practices impact healthcare programs administered by the federal government.
The committee also called on the largest PBMs – CVS Caremark, Express Scripts and Optum Rx – to provide documents, communications and information related to their practices. Calling their practices "anticompetitive," Comer said they're distorting the pharmaceutical market and limiting high-quality care.
CVS Health's CVS Caremark, Cigna's Express Scripts and UnitedHealth Group's Optum Rx control an estimated 80% of the PBM marketplace, according to the House Committee.
This week, in a unanimous 26-0 vote, the Senate Finance Committee passed a comprehensive draft package that puts pharmacy benefit manager reform and mental health in the spotlight. The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act would introduce more transparency and regulation to PBMs, and pharmacies would be required to report costs for medications. The act would essentially be paired with provisions in the Modernizing and Ensuring PBM Accountability Act (MEPA), which passed earlier this year.
ON THE RECORD
"I've seen firsthand how high prices for insulin and other necessary medications can cause patients to limit or skip doses," said Optum Rx CEO Dr. Patrick Conway. "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."
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
