UnitedHealth Eases Rules on Prescription Drug Renewals

The move, which will take effect on May 1, aims to reduce administrative burdens on patients and healthcare providers.

UnitedHealth Group’s pharmacy benefit manager, Optum Rx, has recently announced that it will ease prior authorization requirements for 80 prescription drugs.

The move, set to take effect on May 1, aims to reduce administrative burdens for patients and healthcare providers.

The revised policy will eliminate up to 25% of reauthorization requirements, covering more than 10% of all pharmacy authorizations.

This change is expected to improve medication adherence and streamline access to essential treatments.

"We put a clinical lens on this. For these drugs, adherence over time is the major benefit," said Patrick Conway, CEO of Optum Rx. "You want patients to maintain their cystic fibrosis, asthma, and diabetes drug because it maintains their health and their total cost of care."

The new policy includes medications such as Amgen’s migraine treatment Aimovig, Vertex Pharmaceutical’s cystic fibrosis drug Kalydeco, and Regeneron’s cholesterol-lowering medication Praluent.

Background & Industry Scrutiny

The decision follows increased scrutiny of prior authorization practices, particularly after a UnitedHealth executive was killed in December. The incident sparked widespread criticism on social media about insurance policies requiring pre-approval for medications and medical services.

Earlier this year, UnitedHealth addressed these concerns, stating that it would collaborate with policymakers to reduce prior authorization requirements, particularly in its Medicare segment, which serves individuals aged 65 and older or those with disabilities.

According to UnitedHealth, reauthorization requirements are primarily used for medications with safety concerns, those requiring ongoing dose adjustments, or drugs needing additional testing.

However, the company acknowledged that some long-term treatments, such as those for genetic conditions like cystic fibrosis, may not benefit from repeated authorization checks.

Mixed Reactions from Industry Experts

While lawmakers are expected to welcome the policy change, healthcare experts believe it may not significantly reduce the overall administrative burden of prior authorizations across medical services.

"The program’s emphasis on reauthorization is too narrow to reduce the administrative burden of prior authorizations across medical services," said Robert Popovian, founder of healthcare consultancy Conquest Advisors.

Pharmacy benefit managers (PBMs) play a key role in drug pricing and coverage decisions, negotiating costs with pharmaceutical companies, and managing prescription drug payments.

While UnitedHealth’s move is a step toward simplifying access to medications, broader systemic changes may still be needed to address administrative challenges in healthcare.