UnitedHealth eliminates cost sharing for 5 treatments

Insulin, albuterol, epinephrine, glucagon, and naloxone are on the list.

aAbout 18 million people in the United States, or about 7% of adults, reported that they were unable to pay for at least one prescription drug in their homes in the past three months, according to the 2021 West Health and Gallup survey. An adult under 65 years of age compared to an older adult
65 years old.

In July, the UnitedHealth group took a step that could help some of its members cope with soaring drug bills. The health insurer, the largest in the country by several measures, has announced that it will scrap from January 2023 the cost-sharing of insulin and four drugs that tend to be used in emergency situations: albuterol, epinephrine, glucagon and naloxone. The new policy will affect about 8 million people in the fully insured group plans, including 688,000 people who are currently using the medication. Employees of large companies that self-insure are not included.

Asthma patients use albuterol for severe asthma attacks. Epinephrine is used on an as-needed basis for severe allergic reactions, while glucagon is given in emergency situations for low blood sugar. Naloxone is an emergency treatment for opioid overdose.

Its members will benefit from no cost sharing, but so will UnitedHealthcare, the health insurance division of UnitedHealth, says Doug Burns, CEO of MyFreePharmacy, a monthly subscription service for generic drugs. It should improve adherence and reduce costly interventions, including hospitalization, notes Byrnes. “It saves[UnitedHealthcare]millions by making sure you pay for that $200 vial of insulin,” he says. There’s no argument with that from UnitedHealthcare, which said in a prepared statement that the lack of out-of-pocket expenses “would encourage better adherence to medication, and reduce the risks of complications and expensive hospital admissions.”

The high out-of-pocket costs of insulin are a big part of the political debate these days. A provision of the Inflation Reduction Act sets out-of-pocket insulin at $35 per month for people covered by Medicare, although the cap does not extend to those with commercial insurance. Other legislation that would limit personal insulin expenses for people with business insurance has been introduced, and those bills may be voted on this fall.

UnitedHealth did not answer questions from Healthcare Executive Director® that would fill in some details about the expected savings for patients and the savings the company might make from reduced healthcare use.

UnitedHealth and other insurance companies have reported strong financial results recently. Profit levels beat analysts’ expectations, executives said on UnitedHealth’s second-quarter earnings call in July, with revenue up 13% in that quarter, to $80.3 billion. Although Byrnes believes in low-cost access to drugs, he is critical of UnitedHealth’s approach. Aside from insulin, “they are mostly emergency medications,” he said. Byrnes prefers not to share the cost of daily taken medications, such as those that many people take to lower high cholesterol levels or keep blood pressure in a healthy range. “If it were a daily drug, I think it would be more powerful in helping the organs,” says Byrnes. “It’s great getting the headlines saying ‘Hey, we’re sharing the cost.’ But it’s great. It’s not healthcare.”

Deborah Abrams Kaplan is a freelance writer covering medical management and practice topics.

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