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 healthcare 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.
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