Optum Rx standard formularies currently include the weight loss drugs Wegovy and Saxenda, and the PBM is evaluating Zepbound.
Beginning Jan. 1, 2024, Optum Rx will begin offering plan sponsors a new weight management and wellness support program. Called Optum Rx Weight Engage, the program is designed to support employers, health plans and the consumers and provide better health outcomes.
Optum Rx’s program will support the consumer with navigation through their specific benefit coverage, with a specialized provider network and coaching and lifestyle programs. Clients have the flexibility to configure elements that best fit their and their consumers’ needs. Consumers can access coaching either in person or through a digital platform.
U.S. prevalence of obesity increased from 30.5% during the period 1999 to 2000 to 41.9% during the 2017 to March 2020, according to the CDC. Obesity-related conditions, such as heart disease, stroke, type 2 diabetes and certain types of cancer, are among the leading causes of preventable death. Drugs such as Wegovy (semaglutide), Saxenda (liraglutide) and the newest weight loss drug Zepbound (tirzepatide) activate receptors of hormones secreted from the intestine — glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) — to reduce appetite and food intake.
Optum Rx standard formularies include Wegovy and Saxenda, and a spokesperson said Optum Rx is evaluating Zepbound. Express Scripts and Cigna recently announced they would add Zepbound to their formularies.
Also beginning in January 2024, Optum Rx will shift eight insulin products, including all short- and rapid-acting insulins, to tier one, or “preferred” status, on standard formularies. Three manufacturers will have products added to tier one, including Eli Lilly, Novo Nordisk and Sanofi. As a result, 98% of all Optum Rx consumers will have access to insulin for $35 or less per month.