As of today, Optum Rx is nixing reauthorization requirements for more than 60 additional medications.
The pharmacy benefit management giant revealed a list of drugs that includes products for behavioral health, HIV, dry eye disease, high cholesterol and hypertension. This is the latest step in the PBM's push to ease prior auth for medications that treat chronic conditions, with the goal of reducing prior auth requests for these products by 25%.
Optum said this will equal about 10% of total pharmacy prior auth requests. It's already eliminated the requirements for about 140 medications so far, according to the announcement.
“Chronic conditions affect about 60% of Americans and are the leading cause of death in the United States,” Sumit Dutta, M.D., chief medical officer of Optum Rx, said in the announcement. “Eliminating reauthorization requirements for established and effective treatments underscores our commitment to make these needed drugs more accessible, which also supports better health outcomes.”
Optum determines which products can be included through its pharmacy and therapeutics committee, an independent body made up of pharmacists and physicians that evaluates drugs based on clinical evidence.
The PBM said it will continue to expand the list of medications eligible to skip prior auth. It added that the move builds on other steps it has taken to improve transparency and the member experience. Optum also committed to pass through 100% of negotiated rebates to plan sponsors and to better align payments to pharmacies to the acquisition costs they pay for drugs.
The news also comes shortly after Optum Rx's sister company, UnitedHealthcare, joined a slew of other major insurers in promising significant reforms to prior auth.