Tailoring pharmacy benefits for women's unique health needs

For plan sponsors, a dedicated women’s health strategy is no longer a niche benefit consideration. It is crucial for improving member health outcomes and supporting its workforce.

As a result of these disparities:  

• Women have higher health care utilization than men.¹ 
• Women experience more years of poor health.² 
• Women spend more out of pocket on health care and prescriptions.³

Optum Rx serves as a strategic partner by bringing together benefit strategy, clinical programs, pharmacy expertise and workforce wellbeing support. 

By connecting capabilities across pharmacy, behavioral health and virtual care, Optum Rx can support whole-person care for women as they move through different stages of life, from reproductive health to menopause and healthy aging. 

The value of ongoing menopause support for women and employers 

During menopause, many women experience one or more of the nearly three dozen recognized menopausal symptoms, and these symptoms often go untreated.⁴ For plan sponsors, the impact shows up as worker absenteeism, lost productivity, and higher medical costs. A Mayo Clinic study estimated that menopause costs the U.S. $1.8 billion per year in lost work time, rising to $26.6 billion per year when medical expenses are included.⁵ 

Moreover, a significant yet often overlooked gap in women’s health emerges during perimenopause, a transitional stage which can begin up to a decade before menopause and affect women as early as their mid-30s. Because symptoms can begin earlier than women expect and vary considerably from person to person, many women may not recognize subtle changes as signs of perimenopause and delay seeking care.  

Optum Rx integrates clinical and lifestyle support to help address gaps in care and support women through one of life’s most significant health transitions. Building on earlier work to advance menopause care, our approach includes:  

• Health assessments to identify menopause stage and evaluate symptom severity. 
• Virtual care from menopause-trained clinicians. 
• Personalized treatment plans that may include FDA-approved hormone and non-hormonal therapies. 
• 24/7 access to digital guidance, education and support, tailored to individual needs. 

Managing the complexities of hormone therapy 

While each woman will experience the symptoms of menopause differently, among most common are vasomotor changes such as hot flashes or night sweats, estimated to affect up to 80% of menopausal women.⁶  

Available treatment options for these symptoms can range from lifestyle modifications to nonhormonal prescription treatments targeting menopausal symptoms to hormone replacement therapy (HRT), such as estrogen alone or with progestin.⁷  

Yet, misconceptions and conflicting information about hormone replacement therapy can also prevent women from accessing appropriate menopause care. Since hormone therapies were first introduced in the 1940s, guidance on their use and utilization has shifted. Usage peaked by the 1990s but began a marked decline following a 2002 study that raised concerns about cancer and cardiovascular risks.⁸

However, subsequent analyses and newer research suggest that the benefit-risk profile of hormone therapy may be more favorable for appropriately selected women who begin treatment before age 60 or within 10 years of menopause.⁹ Despite this evidence supporting a more favorable benefit-risk profile for many appropriately selected patients, use of hormone therapy has remained well below pre-2002 levels.¹⁰

Yet the consensus for hormone therapy to manage menopause symptoms continues to grow. In November 2025, the FDA initiated the removal of certain boxed-warning statements from menopausal hormone therapy labels. By October 2026, the agency had approved revised labeling for several products, removing boxed-warning statements related to cardiovascular disease, breast cancer and probable dementia.

In addition, the American College of Obstetricians and Gynecologists (ACOG) recently updated its clinical guidelines for menopause care. The ACOG guidelines say that the timing of hormone therapy should be considered as part of individualized, shared decision-making, with particular attention to age, time since menopause, symptoms, medical history and baseline risks.¹¹

One consequence of this renewal of interest in HRT is that for some drugs demand is outstripping supply. In September 2026, the FDA acknowledged that some patients were having difficulty accessing their usual estradiol transdermal patches because of increased demand and said it was working with manufacturers to increase supply. Optum Rx is monitoring supply and ensuring access as demand continues to grow.

Why a women’s health strategy must go beyond conditions exclusive to women

The importance of a targeted intervention for menopause is borne out in the numbers. For example, systemic use of HRT is shown to reduce the frequency of vasomotor symptoms by approximately 75%.¹²

Beyond relief for symptoms unique to menopause, these therapies can help address conditions that impact women disproportionately or differently than men.  

One condition exemplifying this disproportionate impact is osteoporosis. A chronic condition, osteoporosis causes bones to prematurely weaken with age, increasing the risk of fractures. Osteoporosis is approximately four times more prevalent among women in the U.S., impacting an estimated 19.6% of females over age 50, compared with 4.4% of males.¹³ Consequently, osteoporosis agents are among the drug classes with highest spend across women’s health conditions.¹⁴

A preventive approach to bone health can help women reduce their risk of osteoporosis and fractures as they age. One study associated early initiation of HRT after menopause with a 13% lower relative risk of fracture.¹⁵ Earlier intervention may also help avoid the significant health and financial impacts associated with fractures, with one study finding that first-year direct health care costs following a hip fracture averaged $59,327 among commercially insured women.¹⁶

Also prominent among the conditions affecting women differently or disproportionately are obesity¹⁷ and type 2 diabetes.¹⁸ Given the rising use of GLP-1 medications in treatment of these conditions, plan sponsors need dedicated strategies that balance access, affordability and long-term outcomes while supporting clinical appropriateness and cost control. The GLP-1 Management Suite was created to help plan sponsors manage access to medications to treat diabetes and obesity while supporting clinical appropriateness and cost control.

Moreover, since improved long-term outcomes for those taking GLP-1 medications are often tied to behavioral and lifestyle changes, Optum Rx offers dedicated clinical programs. For members prescribed GLP-1s for diabetes, the Optum Rx Diabetes Management Program offers personalized support through coaching, free supplies and digital tools. For members seeking or with obesity prescriptions, Optum Rx Weight Engage combines clinical rigor with patient monitoring, motivation and support tools to help them sustain and optimize their weight-management journeys.

While menopause may be one of the highest drivers of pharmacy spend among conditions that exclusively affect women, a larger opportunity lies in proactively managing high-cost conditions that impact women disproportionately or differently.

A holistic approach to women’s health

Supporting women’s health is an important part of building a healthier, more resilient workforce. Progress in affordability is helping make important treatments more accessible. Greater use of lower-cost generics has helped reduce costs across several areas of women’s health, including contraceptives, estrogen therapies and osteoporosis treatments.

But supporting women’s health means looking beyond reproductive care alone. Women’s health needs evolve throughout their lives, from pre-menopause and perimenopause through post-menopause and healthy aging. A more holistic approach that prioritizes affordability, well-being and personalized support can help women access care that reflects their individual needs and get more value from their pharmacy benefits.

Optum Rx is committed to helping plan sponsors advance a more integrated women’s health strategy that addresses evolving health needs, enhances the member experience and supports better outcomes across every stage of life.