Vertex Newly Approved Pain Treatment Lands Higher Cost Tier 3 Placement In UnitedHealth's Optum Rx Formularies

In January, the Food and Drug Administration (FDA) approved Vertex Pharmaceuticals Inc. VRTX Journavx, a non-opioid oral pain signal inhibitor for acute pain.

This marked the first approval of a new class of pain medication in more than 20 years, offering an alternative to traditional opioid treatments.

According to the Formulary Update released in February, Journavx has been placed on Tier 3 of Optum Rx Premium and Select Formularies and is being further evaluated by the Optum Rx National Pharmacy & Therapeutics Committee for clinical value and safety. Many Tier 3 drugs have lower-cost options in Tier 1 or 2.

Optum Rx, is the pharmacy benefit manager owned by UnitedHealth Group Inc’s UNH

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According to Bloomberg, the interim decision ensures the drug will be covered, but patients may pay more since it’s not in the lower-cost tiers, which usually include generics or preferred brand drugs. This applies to Optum Rx’s Premium and Select formularies for commercial plans.

“With the growing concern over opioid use disorder, new non-opioid alternatives such as Journavx provide additional options for treatment,” the document says.

Citing a BMO Capital Markets analyst, the Bloomberg report notes that a less favorable formulary placement will likely make it harder for some patients to access the medication. The report also notes a challenge Vertex will face: convincing insurers to cover its drug, which costs much more than opioids. The wholesale price is $15.50 per 50 mg tablet taken twice daily.

Concurrently, the UK Medicines and Healthcare products Regulatory Agency (MHRA) approved Vertex’s Alyftrek (deutivacaftor/tezacaftor/vanzacaftor), a once-daily next-in-class triple combination therapy for cystic fibrosis patients ages 6 years and older who have at least one F508del mutation or another responsive mutation in the CFTR gene.

In February, Vertex Pharmaceuticals reported fourth-quarter earnings per share of $3.50, missing the consensus of $3.57.

Sales reached $2.91 billion, up 16% year over year, beating the consensus of $2.78 billion. Annual sales reached $11.20 billion.

Vertex expects 2025 sales of $11.75 billion-$12 billion versus a consensus of $11.84 billion.

Price Action: VRTX stock is up 0.32% at $487.26 at the last check Friday.

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