In a significant development for pain management options, UnitedHealth Group’s pharmacy benefit manager Optum Rx has become the first major insurer to add Vertex Pharmaceuticals’ newly approved pain medication Journavx to its commercial formularies.
The non-opioid pain treatment, which received FDA approval in January 2025, has been placed on Tier 3 of Optum’s formulary as part of an interim decision while formal evaluation continues. This tier typically encompasses higher-priced branded medications and select generic drugs.
Journavx, designed to treat acute pain following surgery or injury, represents a novel approach to pain management. With a daily list price of $31, the medication costs substantially more than generic opioid alternatives, leading to questions about market access and adoption.
Prior to the drug’s approval, Vertex’s chief operations officer Stuart Arbuckle acknowledged that pricing and accessibility were primary concerns raised by stakeholders. However, he indicated that
discussions with insurance providers were proceeding positively.
A spokesperson for Vertex, Heather Nichols, expressed satisfaction with Optum’s decision, noting that it recognizes both the unmet need for new pain treatments and Journavx’s potential. The company continues to engage with Optum and other insurers to expand
availability.
According to Elizabeth Hoff, speaking for Optum’s pharmacy care services division, the organization’s clinical review team is still examining Journavx’s clinical data before making final recommendations on formulary placement. The current listing allows immediate access to a non-opioid option for moderate to severe acute pain.
Industry analysts have responded favorably to this development. Cantor Fitzgerald’s analysis, based on discussions with a UnitedHealth Group senior director of product development, suggested that broad coverage for Journavx was likely due to increasing pressure on insurers to provide non-opioid pain management alternatives. The director also indicated that step therapy requirements, which typically require patients to try less expensive options first, might not be implemented for Journavx.
Leerink Partners analyst David Risinger characterized UnitedHealth’s initial coverage decision as “encouraging” for the drug’s prospects. Other major healthcare companies, including CVS, Humana, and Cigna, have not yet publicly announced their coverage plans for the medication.
The coverage landscape for Journavx has begun to take shape at the state level as well, with Medicaid programs in New York and Arkansas implementing policies regarding the drug’s coverage. This early adoption by state programs could signal broader acceptance in the healthcare system.
This coverage decision represents a crucial first step for Vertex’s new pain medication, which some analysts predict could achieve multibillion-dollar sales. However, the drug still faces significant commercial challenges, particularly given the entrenched position of cheaper opioid alternatives in the pain management market.
Optum’s decision to place Journavx on its formulary while continuing formal review demonstrates a balanced approach between providing immediate access to novel non-opioid pain management options and ensuring thorough evaluation of clinical evidence. The placement on Tier 3 indicates that while the drug is covered, patients may face higher out-of-pocket costs compared to lower-tier medications.
As other major insurers and pharmacy benefit managers evaluate Journavx, their coverage decisions will play a crucial role in determining the drug’s commercial success and its accessibility to patients seeking non-opioid pain management options.