[itissteve]

UnitedHealthcare's new standard benefit will become part of fully-insured coverage as early as Jan. 1.

Insulin and the other drugs are already covered by the company's health plans, but cost-sharing rules can still leave patients with significant out-of-pocket costs.

As one of the largest insurers in the country, I'm interested to see if other insurers pick up on this. Of course, I'm not naive enough to believe UHC isn't looking at ways to cover the revenue the copay used to bring in. But in my opinion it's a step in the right direction.

 

[MaJoie]

UnitedHealthcare's new standard benefit will become part of fully-insured coverage as early as Jan. 1.
Insulin and the other drugs are already covered by the company's health plans, but cost-sharing rules can still leave patients with significant out-of-pocket costs.

As one of the largest insurers in the country, I'm interested to see if other insurers pick up on this. Of course, I'm not naive enough to believe UHC isn't looking at ways to cover the revenue the copay used to bring in. But in my opinion it's a step in the right direction.

Doesn't the copay go to the pharmacy? How would the insurance company lose revenues if the government (ie taxpayers) pay the copays? Negotiating drug prices will potentially save money for both US government and insurance companies. Am I misunderstanding something here?

 

[itissteve]

Drug prices in the U.S. are a complicated weave of costs and payments among manufacturers, insurers, pharmacy benefit managers (PBMs), and customers. If UHC is dropping the copay for their customers, that money almost certainly will be made up somewhere along the line. Will it come in the form of higher premiums for the insurance plans that offer no copays for insulin (or epi pens or so on)? Will UHC lean on PBMs and manufacturers to lower the price of insulin enough to make up for the copay? Will UHC decrease their profits to cover this amount?

Negotiating drug prices can save money for health insurance providers and, perhaps and indirectly, consumers (whether they're insureds or taxpayers). Perhaps I'm jaded in thinking that there is enough money and influence involved that a reduction in one area will be compensated for (perhaps more than necessary) in another area which is not so apparent.