UnitedHealth Group’s pharmacy benefit manager OptumRx plans to cut up to 25% of its medication reauthorizations.
OptumRx will trim reauthorization requirements for about 80 drugs beginning May 1 and will consult with physicians and pharmacists to expand the list of medications over time, the company said in a news release Wednesday.
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Reauthorization is a type of prior authorization, a process used by insurers and PBMs to help determine the medical necessity of services, procedures and medications before coverage. Insurance companies and PBMs require patients and clinicians to obtain reauthorizations for some drugs in cases of long-term safety concerns or potential dosing changes.
"The prior authorization program, which I'm responsible for, always goes through continuous improvements. All of our criteria sets are reviewed by our independent [pharmacy and therapeutics] process, and we monitor the program on a weekly basis," said OptumRx Chief Medical Officer Dr. Sumit Dutta. "We are also responding to the environment."
The cuts will account for more than 10% of OptumRx's total pharmacy prior authorizations, the release said.
"All of the drugs in this program will go through the first prior authorization process, and then this focuses on those conditions where things don't change much," Dutta said.
New drugs for Alzheimer's disease may be a good fit for the renewal process, while treatments for cystic fibrosis may not need reauthorizations, the company said in the release.
“These changes mean easier access to medications for consumers, less work for pharmacists and physicians and a simplified system focused on clinical quality," OptumRx CEO Dr. Patrick Conway said in the release.
UnitedHealth Group and other insurers have faced a wave of scrutiny, particularly since the killing of former UnitedHealthcare CEO Brian Thompson in December, over their use of prior authorization.
The company vowed to scale back the practice on an earnings call with investors in January. Earlier this month, UnitedHealth Group's insurance business UnitedHealthcare said it would cut nearly 10% of prior authorizations this year.
OptumRx also continues investing in technology geared toward easing patient and provider experiences. The PBM plans to roll out a tool that pulls information from electronic health records to answer questions to automatically approve claims, Dutta said.
