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Optum RX targets cuts to prior authorization for some meds

The move to scrap reauthorization for 80 prescription drugs will ultimately eliminate 10% of prior authorization requirements.

Sara Heath
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Published: 19 Mar 2025

Optum RX, a subsidiary of UnitedHealth Group, is getting rid of a quarter of its reauthorizations, or more than 10% of overall pharmacy prior authorizations, the company said in a public announcement.

The move, which will focus first on around 80 drugs, was designed to make it easier for patients and their providers to access medications. Prior authorization has been the target of industry scrutiny, with clinicians and patients alike decrying the practice as restrictive.

An American Medical Association (AMA) survey of physicians recently found that prior authorization can lead to care delays and treatment abandonment. Per the survey, more than a quarter of physicians say prior authorization has led to a serious adverse event for a patient in their care.

That is because prior authorization requires healthcare providers to file a request with the healthcare payer to receive approval for a certain medication. A June 2024 report from AMA showed that 27% of prior authorizations are often or always denied by insurance companies.

Indeed, prior authorizations are a key cost and utilization management strategy for healthcare payers. However, Optum RX's announcement to reduce the number of required prior authorizations indicates a move toward a more streamlined approach, the pharmacy benefit manager (PBM) indicated.

"Optum Rx is taking meaningful steps to simplify patient experiences and increase access to critical medications," Patrick Conway, M.D., chief executive officer at Optum Rx, said in a press release. "These changes mean easier access to medications for consumers, less work for pharmacists and physicians and a simplified system focused on clinical quality."

Making the case for prior authorizations

Optum RX said that prior authorization and reauthorization -- the practice of extending or renewing an initial prior authorization -- are important for continuous review of medication safety and dosage. The PBM said that these strategies are important for ensuring that the current drug is still safe and appropriate to treat a patient's condition.

This is applicable for some of the newly developed Alzheimer's drugs, Optum RX said, which can carry some risks and have a limited evidence base of long-term effectiveness. In these cases, Optum RX said prior authorization and reauthorization would make sense.

But for a patient with an established diagnosis of a genetic condition like cystic fibrosis, these policies might be counterintuitive.

Reducing prior authorization and reauthorization

Optum RX said it is starting with a list of 80 drugs that it will remove from its reauthorization list. That accounts for around a quarter of reauthorizations and 10% of overall prior authorizations.

The PBM also said it will work with physician and pharmacist partners to expand that list over time.

Per Axios reporting, the policy will go into effect on May 1 of this year. It will target prescription drugs for cystic fibrosis, asthma and other chronic conditions, the publication said.

Sara Heath has reported news related to patient engagement and health equity since 2015.

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