UnitedHealth Group’s pharmacy benefit manager, Optum Rx, announced on Wednesday that it will be simplifying the process for obtaining insurance authorization when renewing prescriptions for approximately 80 drugs. This change is aimed at reducing paperwork for both patients and doctors. The initial list of drugs targeted for this streamlined process may expand in the future, ultimately eliminating up to 25% of reauthorization requirements, which currently make up over 10% of all pharmacy authorizations.
Following the tragic death of a UnitedHealth executive last December, there was a wave of complaints on social media about the complexities in insurance processes, including the need for approval on medications. In response to this feedback, UnitedHealth stated in January that it would collaborate with policymakers to lessen the frequency of prior authorizations in their Medicare business for individuals aged 65 and older or with disabilities.
Reauthorizations are essential for drugs with safety considerations, requiring ongoing monitoring for dosage adjustments or additional tests. UnitedHealth’s unit emphasized the importance of continuous review for newly approved drugs like those for Alzheimer’s, while highlighting that for genetic conditions such as cystic fibrosis, reauthorization may provide minimal value.
Pharmacy benefit managers like Optum negotiate drug prices and manage coverage lists for health plans, serving primarily employers and government programs. These managers, including CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth’s Optum, dominate the U.S. pharmacy benefit market, with their parent companies involved in health insurance and pharmacy operations as well.
Criticism has been directed towards these managers for contributing to rising drug costs, prompting President Donald Trump to express interest in addressing their role in the industry.
