Thursday, August 04, 2022

UHC's August 2022 Optum Insulin Announcement: More PR Fluff? We Don't Really Know.

On August 1, 2022, United Healthcare Group's PBM business known as Optum made a press release of its own related to insulin:

Optum to Offer Lower-Cost Insulin for Uninsured People Living With Diabetes on Optum Store

This comes on the heels of United Healthcare's own goodwill-generating PR move made on July 15, 2022 which was as follows:

UnitedHealthcare To Eliminate Out-of-Pocket Costs on Several Prescription Drugs, Including Insulin, for Eligible Members

I quickly tore the United Healthcare announcement to shreds, citing the headline which said it ONLY applied to "Eligible Members", and how healthcare insurance industry critic Wendell Potter did the math in his own article (see for his assessment) on the United Healthcare announcement, concluding "The money 1.3% of United's health plan members might save in out-of-pockets on insulin and a few other medications likely won't amount to a rounding error for this enormous company."

Regardless, Optum's own, more recent goodwill gesture deserves its own assessment, so here it is.

First, Optum's press release was deliberately vague, saying:

"People can access Optum Store to determine whether their insulin is part of the affordability program, get qualified and download an insulin savings card, and then fill their prescription at the $35 price point at any retail pharmacy."

Let me start by saying that any patient, using a Sanofi ValYou coupon, can now buy any Sanofi insulin for a price of $35/vial, and from virtually any pharmacy. Patients don't need to buy it online from Optum Store. So that struck me as rather odd.

That said, it's also completely unclear if any of the Optum PBM's preferred "formulary" brands of insulin (currently, the UHC preferred formulary brand of insulins for 2022 are those made by Eli Lilly & Company, which includes such brands such as Lyumjev, the marginally faster prandial analogue approved by the FDA on June 15, 2020). 

It's very possible the Optum move merely includes insulin varieties sold to anyone at a discount with a manufacturer or PBM coupon, such as "authorized generic" products such as Lilly Insulin Lispro Injection U-100, as well as Sanofi's entire insulin portfolio, which that company announced effective July 1, 2022 would be available to anyone with a Sanofi ValYou coupon (see my coverage HERE). The press release said: "By working with Sanofi, we will improve access and lower costs for people who need this life-saving medication."

So, it appears Optum is using Sanofi's previously-announced insulin price-cut to make itself look like a hero. My biggest question is whether Optum will offer consumers via its Optum Store the same discounts it offers to its insurance plan sponsor clients, such as branded Lilly insulins such as Lyumjev or Humalog?

We simply don't know these answers to my question. 

But if it's anything like the July 15, 2022 United Healthcare insulin announcement, it looks more like the company is simply trying to prove to lawmakers in Congress its actually doing something while actually doing nothing (positioning a program already announced by Sanofi as something Optum is doing to try and ensure widespread insulin affordability while keeping its formulary brands out of the hands of masses.

Americans are growing tired of the insurance company/PBM complex PR stunts. We KNOW with absolute certainty that PBM's are responsible for drug list price growth, and the reality that patients satisfying deductible are forced to pay list prices. Instead, Optum might want to make Optum Store a destination to access the company's entire negotiated price portfolio; that might shake things up. But we can expect them not to do so because they don't want to cannibalize their own plan-sponsor clients. Even though they do just that.

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