Nebraskans to benefit from $0 co-pays for insulin, emergency drugs

UnitedHealthcare says it will eliminate out-of-pocket costs for insulin and several drugs used in medical emergencies for some members as early as Jan. 1, 2023.

In addition to short- and long-acting preferred insulins, four emergency medications — epinephrine, including EpiPens (for severe allergic reactions), albuterol inhalers (for acute asthma attacks), naloxone (for opioid overdoses) and Glucagon (for hypoglycemia) — will be offered at $0 cost share to members of fully insured group plans, subject to any required regulatory approval.

UnitedHealthcare officials said the initiative is aimed at ensuring that people get the drugs they need and making health care more affordable. Nearly 8 million of the company's members are covered under fully insured plans. The insurer has just over 500,000 members in Nebraska.

"High prices are a significant barrier to prescription drugs for many people, so we are using our unique capabilities to deliver savings for consumers," Brian Thompson, UnitedHealthcare's CEO, said in a prepared statement. "We are doing what we can to shield people from the prices set by pharmaceutical companies and hope all stakeholders also will act to make prescription drugs more affordable."

The move comes as Senate Democrats seek to pass a measure that would give Medicare the power to negotiate prices on some of the costliest drugs.

Insulin would not be covered under the bill, the Washington Post reported, because the drugs will have generic competition. Also left out is a $35 proposed cap on the co-pay for insulin that had been included in early drug-pricing proposals. Democratic leaders reportedly are considering adding an insulin provision back into the reconciliation bill. More than 7 million Americans with diabetes need insulin to survive.

Fifteen states, starting with Colorado in 2015, have enacted their own caps on insulin costs in response to concerns that the high cost of the drug is causing people to skip doses or ration it.

Blue Cross Blue Shield of Nebraska began offering a $0 cost share for preferred insulins to members with diabetes who are covered under fully insured employer group health plans on Jan. 1.

Medica in 2021 began offering a $25 cap for a month's supply of insulin under its group plans in Nebraska and three counties in southwest Iowa — Pottawattamie, Mills and Harrison — and to individual plan members in Nebraska with coverage under the Affordable Care Act.

However, neither the $0 co-pays nor the caps address the underlying costs of insulin, which are rising. That has been a concern voiced by critics of attempts to enact a federal cap, in particular.

EpiPens, too, have been the subject of outcry about price increases. Generics first became available in late 2016.

UnitedHealthcare officials said the company, and subsidiary Optum, recognize their responsibility to encourage collaboration and cooperation to help make prescription drugs more affordable.

"We encourage other parts of the drug supply chain to follow our action today and join us in collaborative efforts that will make prescription drugs more affordable for patients," company officials said in a statement.