top of page

Optum Rx | 2024 News | Updates | iPharmaCenter

November 09, 2023

Optum Rx Implements Initiatives to Reduce Insulin Expenses

Commencing on January 1, 2024, Optum Rx is undertaking substantial measures to improve the affordability of insulin. The company is shifting eight preferred insulin products to tier one on standard commercial formularies, setting a maximum limit of $35 for out-of-pocket expenses.

As a pharmacy services company, Optum Rx is devoted to enhancing insulin accessibility. This initiative entails reclassifying various rapid--, short--, and long-acting insulins to tier one, ensuring consumers benefit from the most economical prices. Optum Rx aims to shield consumers from the exorbitant prices set by drug manufacturers and guarantee access to cost-effective medications.

A total of eight products, covering all short- and rapid-acting insulins, will transition to tier one or "preferred" status on standard formularies. Eli Lilly, Novo Nordisk, and Sanofi, three major manufacturers, will see their products elevated to tier one.

In 2022, Optum Rx collaborated with UnitedHealthcare to eliminate copays for insulin and critical drugs in group fully insured plans. This initiative covered medications for emergencies such as severe allergic reactions, hypoglycemia, opioid overdoses, and acute asthma attacks. The Optum Rx Critical Drug Affordability program, encompassing 170 unique medications, advocated for a cost share of $35 or less for consumers.

Presently, over 70% of Optum Rx users pay less than $35 per month for insulin. With the recent measures, effective January 1, 2024, a remarkable 98% of all Optum Rx consumers will enjoy access to insulin for $35 or less per month.

It's vital to acknowledge that prescription drug prices are determined by drug manufacturers. Optum Rx, functioning as a pharmacy benefit manager, acts as a counterforce to manufacturers, actively working to lower drug costs. This formulary decision aligns with Optum Rx's persistent endeavours to shield consumers from escalating drug prices and broaden their options.

In January, Optum Rx introduced Price Edge, a consumer solution facilitating seamless comparisons between direct-to-consumer pricing for traditional generic drugs and insurance pricing. This ensures Optum Rx users consistently access the most economical prescription drug prices available. The company remains steadfast in its commitment to introducing additional products, services, and policies to amplify medication affordability and empower consumers to make informed healthcare decisions.



bottom of page