Optum Rx Moves 8 Insulins To Its Preferred Formulary Tier

Optum Rx is shifting eight different insulin products to its preferred formulary in a bid to address affordability, the company said Thursday.

The product selection includes all rapid-acting and short-acting insulin products as well as some long-acting insulins, according to the announcement. It includes insulins manufactured by Sanofi, Novo Nordisk and Eli Lilly.

Optum’s Tier 1 includes the lowest cash prices that its members will pay, the company said.

“I’ve seen firsthand how high prices for insulin and other necessary medications can cause patients to limit or skip doses,” said Patrick Conway, M.D., CEO of Optum Rx, in the release. “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.”

In 2022, Optum worked with its sister company, UnitedHealthcare, to reduce the out-of-pocket costs on several drugs, including insulin, to $0. It also joined forces with Sanofi that same year to offer 30-day supplies of insulin for uninsured diabetic patients through Optum Store at a $35 price point.

At present, 70% of Optum Rx members can access insulin for $35 per month or less. With the latest program taking effect Jan. 1, that number will increase to 97%, Optum said.

In the release, Optum said the move highlights the role pharmacy benefit managers play as a “counterweight” to pharmaceutical manufacturers in the war over drug pricing. PBMs have been under the microscope in Congress of late as policymakers weigh solutions to address rising 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,” Optum said.


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