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OptumRx will favor the reference product Lantus on the Premium Formulary. The organization also released coverage information about other newly approved therapies.
Semglee (insulin glargine-yfgn) will be excluded on OptumRx’s Premium Formulary and will be placed on Tier 3 with step therapy on OptumRx’s Select Formulary, according to an October 2021 update from the company.
OptumRx's current preferred long-acting insulin products are Lantus and Toujeo. These offer the lowest net cost long-acting insulin options and are Tier 2 on the OptumRx Premium and Select Formularies, according to OptumRx.
With the availability of an interchangeable biosimilar Semglee, OptumRx is evaluating potential strategies that may further reduce costs in the long-acting insulin category, according to the company.
Two other PBMs — Prime Therapeutics and Express Scripts — will remove Lantus from their formularies and include Semglee as the preferred therapy beginning January 2022.
The FDA approved Semglee, developed by Viatris and Biocon Biologics, in July 2021 to improve glycemic control in adults and pediatric patients with type 1 diabetes and in adults with type 2 diabetes. It is interchangeable with Lantus, a long-acting insulin analog. Semglee, offered in 10 mL vials and 3 mL prefilled pens, is administered subcutaneously once daily.
Viatris/Biocon recently launched Semglee both as a branded and nonbranded product. The currently marketed non-interchangeable Semglee will be phased out by the end of the 2021, according to a statement from the companies.
Viatris has established several programs to help to help with patient access, including a patient assistance program, a copay program that limits out-of-pocket expenses, and a program for Medicare Part D that limits out-of-pocket expenses to no more than $35 a month.
OptumRx has also made decisions about other therapies approved this year, including: