Optum Rx has added more than 60 additional drugs to a list for which it is eliminating reauthorization requirements, including products for HIV, behavioral health and hypertension.
The company's Pharmacy and Therapeutics Committee – which comprises practicing physicians and pharmacists – has identified the products as drugs for which reauthorizations would provide only minimal value.
So far this year, Optum Rx has eliminated reauthorization requirements for more than 140 chronic disease medications.
"Chronic conditions affect about 60% of Americans and are the leading cause of death in the United States," said Dr. Sumit Dutta, chief medical officer for Optum Rx. "Eliminating reauthorization requirements for established and effective treatments underscores our commitment to make these needed drugs more accessible, which also supports better health outcomes."
WHAT'S THE IMPACT
The move to eliminate reauthorization requirements is part of a commitment Optum Rx made earlier this year to simplify access to consumer drugs. The company said it will work to eliminate up to 25% of reauthorizations, which is said is equal to more than 10% of overall pharmacy prior authorizations.
The initiative started with about 80 drugs, with room to expand the list over time.
Optum Rx said that while some reauthorizations are necessary for drugs that have safety concerns, or need ongoing monitoring for dose adjustments, once a genetic condition like cystic fibrosis is confirmed through testing, "there is minimal additional value in reauthorizing an effective, lifelong treatment."
The company is also engaging in other initiatives meant to lower drug costs, such as financial assistance programs, including Optum Savings IQ, which matches eligible Optum Specialty patients with financial resources and programs to lower their out-of-pocket costs for specialty medications.
Other initiatives from Optum Rx include the Critical Drug Affordability List, which caps out-of-pocket costs on more than 290 medications; Price Edge, a digital price comparison tool that has generated $224 million in consumer savings; PreCheck MyScript, which automatically scans drug prices to provide real-time price information; Proactive Savings Alerts, which notifies consumers of savings opportunities; and MyScript Finder, which enables consumers to see the price of their prescribed medication.
THE LARGER TREND
UnitedHealthcare faced a backlash of anger over prior authorizations and claim denials after its CEO Brian Thompson was fatally shot Dec. 4 as he walked to an investors conference in Manhattan.
Alleged shooter Luigi Mangione faces a first-degree murder charge. In his backpack, police found a manifesto outlining issues with the large health insurance industry.
UnitedHealth Group CEO Andrew Witty addressed the vitriol against the company in an op-ed published in The New York Times in late December 2024.
"We know the health system does not work as well as it should, and we understand people's frustrations with it. No one would design a system like the one we have. And no one did. It's a patchwork built over decades. Our mission is to help make it work better," Witty wrote, adding that the nation's largest insurer, UnitedHealthcare, was willing to partner with healthcare providers, employers, patients, pharmaceutical companies, governments and others to find ways to deliver high-quality care and lower costs.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.