UPDATED: UnitedHealthcare Makes Formulary Changes for Medicare Plans


UnitedHealthcare is moving more drugs to the lower-cost tiers in its Medicare Advantage plans. Other plans will have $0 copays and insulin at a $25 copay.

UnitedHealthcare is offering expanded access and lower prescription drug costs for some 2023 Medicare Advantage and prescription drug plans. The insurer that 99% of members in standard and Chronic Special Needs Plans (C-SNPs) will have stable or reduced premiums – including nearly 3.3 million members with a $0 premium – and all will have stable or improved core and prescription drug benefits.

Additionally, all Medicare Advantage members will see stable ancillary benefits, with 91% receiving better-than-ever ancillary benefits like dental, hearing, over-the-counter and prescription drug coverage. The Medicare Advantage formulary will have more drugs in tier 1 and move even more commonly used drugs to lower tiers, which target conditions such as cardiovascular disease, depression, osteoarthritis, glaucoma, and overactive bladder. (See table below for a list tier changes.)

More plans will lower tier 1 retail copays to $0, giving nearly all members in standard plans and Chronic Special Needs Plans (C-SNPs) free access to the most common adherence medications. And 100% of members will have $0 tier 1 and 2 copays through Optum Home Delivery, up from 93% in 2022. Additionally, 87% of members will have no Rx deductibles, up from 59% in 2022.

All members without Extra Help enrolled in C-SNPs will have access to insulin at $25 ($10 less than standard plans) in addition to diabetic supplies on tier 2, giving access to $0 copays for supplies when using home delivery. C-SNP members will also have access to eight medications on a lower drug tier that target cardiovascular disease.

UnitedHealthcare will continue to expand access to $0 copays on covered drugs to 96% of its members enrolled in Dual Special Needs Plan (D-SNP).

Annual enrollment for Medicare begins Oct. 15, 2022, and continues through Dec. 7, 2022.

* updated to include table with tier changes

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