Optum to drop prior authorization requirement for dozens of drugs
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Optum Rx — which includes the pharmacy benefit manager of health care conglomerate UnitedHealth Group — is dropping annual reauthorization requirements for 80 drugs, which will eliminate more than 10% of overall pharmacy prior authorizations, the company announced.
Why it matters: Prior authorizations have rocketed to the center of health care policy conversations, driven largely by patients' frustration with a practice that can result in delayed or even denied care.
What they're saying: The company identified drugs that are "no longer clinically necessary to review" every year, said Patrick Conway, CEO of Optum Rx.
- These include medications for cystic fibrosis, asthma and other chronic diseases. "We can make it simpler for doctors, pharmacists and patients," Conway said.
- The change will eliminate up to one-quarter of total drug reauthorizations, the company said. The program begins on May 1, and the list of included drugs will expand over time.
- The company said earlier this year that it will pass 100% of drug rebates negotiated with manufacturers to its clients.
Between the lines: Although the Biden administration attempted to streamline the use of prior authorizations by insurers through regulation, drugs were exempted from new federal rules last year.
- And PBM business practices — including rebates — have long been criticized by lawmakers of both parties, leading to a slew of legislation in recent years.
- A bipartisan PBM reform bill nearly passed at the end of last year but failed to make it across the finish line.
- Optum's changes are "responsive to customers and the environment," Conway said.
The big picture: Although Optum is separate from UnitedHealth Group's insurance arm, UnitedHealthcare, the insurance industry as a whole is facing a reckoning over its use of prior authorizations.
- The public response to the killing of UnitedHealthcare CEO Brian Thompson late last year has revealed deep antipathy toward the health care industry. One poll found that American adults are nearly as likely to blame insurance denials for Thompson's killing as they are to blame the person who shot him.
- UnitedHealthcare has a goal of eliminating around 10% of its prior authorization requirements this year.
