Quarter of Reauthorizations Eliminated
Optum RX, a UnitedHealth Group subsidiary, is eliminating 25% of its medication reauthorizations, representing over 10% of all pharmacy prior authorizations. This significant change aims to improve medication access for patients and providers, addressing a practice that has faced intense industry criticism.
Prior Authorization Under Scrutiny
Recent American Medical Association (AMA) research reveals troubling consequences of prior authorization requirements. More than 25% of physicians report that these requirements have caused serious adverse events for their patients. Additionally, a June 2024 AMA report found that insurance companies deny 27% of prior authorization requests either often or always.
Streamlining Patient Access
The prior authorization process requires healthcare providers to seek payer approval before prescribing certain medications. While this serves as a key cost and utilization management strategy for insurers, Optum RX’s reduction signals a shift toward a more patient-friendly approach.
“Optum Rx is taking meaningful steps to simplify patient experiences and increase access to critical medications,” stated Patrick Conway, M.D., Optum Rx CEO. “These changes mean easier access to medications for consumers, less work for pharmacists and physicians and a simplified system focused on clinical quality.”
Balancing Safety and Access
Optum RX maintains that prior authorization and reauthorization processes play important roles in ongoing medication safety review. The company argues these strategies remain appropriate for newer treatments with significant risks or limited long-term efficacy data, such as some recently developed Alzheimer’s medications.
However, for patients with established genetic conditions like cystic fibrosis, these requirements may be unnecessary barriers to care.
Implementation Timeline
The policy change begins with 80 drugs being removed from reauthorization requirements, with plans to expand the list through collaboration with physician and pharmacist partners. According to Axios, the policy takes effect May 1, 2024, primarily affecting medications for chronic conditions including cystic fibrosis and asthma.
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