UnitedHealthcare to eliminate out-of-pocket spending on insulin and other essential drugs


UnitedHealthcare will eliminate out-of-pocket costs for insulin and some other essential drugs for nearly 8 million health plan enrollees.

Patient advocates say the move, announced on Friday, is a significant step forward in addressing lingering affordability issues for insulin, a crucial drug for people with diabetes.

They hope the move by Minnetonka-based UnitedHealthcare, the nation’s largest health insurer, could prompt the rest of the insurance market to follow suit.

UnitedHealthcare’s new standard benefit will become part of fully insured coverage starting January 1.

Insulin and other medications are already covered by company health plans, but cost-sharing rules can still leave patients with significant costs.

The zero-outlay commitment also applies to four emergency medications: epinephrine for severe allergic reactions; albuterol for acute asthma attacks; glucagon for hypoglycemia; and naloxone for opioid overdoses.

The aim of the new benefit is to reduce financial barriers to medicines, especially as inflation puts increased pressure on household budgets, chief executive Andrew Witty said on a conference call with officials on Friday. analysts and investors.

“We know we need these people to make sure they fill their prescriptions correctly and if there’s anything caused by the inflationary environment that might be holding it back, there’s going to be a really bad downside to that – and we don’t want that to happen,” Witty said.

The high costs of insulin have emerged in recent years as a prime target for reform by lawmakers and health care providers, including an effort supported in part by the Mayo Clinic to manufacture lower-cost versions.

In 2020, Minnesota lawmakers created a safety net program that provided nearly $6.9 million worth of insulin to patients needing emergency and ongoing access last year.

The underlying problem, critics say, is that even though insulin has been around as a medical product for decades, it still commands high list prices that can impose significant costs on patients while enriching healthcare players. business throughout the pharmaceutical supply chain.

In recent years, several health insurers, including Minnetonka-based Medica, have voluntarily capped payouts at relatively low levels, like $25 or $30 a month. A few insurers — including Eagan-based Blue Cross and Blue Shield of Minnesota — have gone further by eliminating out-of-pocket costs for insulin, said Aaron Turner-Phifer, director of health policy at JDRF, a nonprofit organization. nonprofit that funds diabetes research. treatments while advocating for patients.

UnitedHealthcare’s move should provide a significant boost to the trend, Turner-Phifer said, and could be particularly influential with large employers who self-insure.

“I think that’s an important signal that we’re going to take now when we talk to employer groups and say, ‘United are making this investment. If it makes sense for their fully insured market [customers]it certainly makes sense for your group of insured employees,” he said. “That’s where United, being United, can have a signaling effect.

Not all of the manufacturer’s products in these drug categories will be available without cost sharing. Fees will only be waived for “preferred” drugs, i.e. those listed on the first or second level of the formularies.

Currently, there are 11 different preferred insulin products with UnitedHealthcare coverage. The company says that about 95% of people on fully insured plans who are prescribed insulin currently choose one of the preferred options.

“While this is an important step for the health of vulnerable people, containing the larger and longer-term costs of medicines depends on manufacturers restricting and lowering the list prices of their products – which is the fundamental cost driver,” said Witty, UnitedHealthcare’s chief executive.

The benefit will be part of “fully insured” health plans, where employer groups and individuals pay UnitedHealthcare to take the risk of cost overruns. This will be an option for self-insured plans, where employers assume the financial risk themselves.

Large multi-state employers often operate self-insured plans. Until these companies, along with other health insurers, eliminate insulin cost sharing, some affordability issues will persist, Turner-Phifer said.

The Mayo-based manufacturing initiative, called Civica Rx, remains important as a way to address the underlying cost of insulin, he said. Legislation pending in Congress would also help by addressing both list prices and patient costs in health plans.

“It’s a step on the road to affordable insulin — it’s definitely not the end,” Turner-Phifer said. “We are going to demand several penalty kicks to solve this problem.”


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