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EDEN PRAIRIE, Minn. — Optum Rx, the third largest pharmacy benefits manager, is eliminating up to 25% of reauthorizations, which is equal to more than 10% of overall pharmacy prior authorizations.
“Optum Rx is taking meaningful steps to simplify patient experiences and increase access to critical medications,” said Dr. Patrick Conway, CEO of the UnitedHealth Group subsidiary. “These changes mean easier access to medications for consumers, less work for pharmacists and physicians and a simplified system focused on clinical quality.”
The initiative focuses first on approximately 80 drugs, and the PBM says it will work with physicians and pharmacists to expand the list over time.
Medication authorizations are important for ensuring safe, appropriate, evidence-supported use of drugs. Some reauthorizations are necessary for drugs that have safety concerns, need ongoing monitoring for dose adjustments, require additional tests or may have alternative therapy considerations.
For example, new drugs developed for Alzheimer's disease carry risks for the brain, and long-term effectiveness is not clear. For these treatments, ongoing review is important for patients, payers and physicians. In contrast, once a genetic condition like cystic fibrosis is confirmed through testing, there is minimal additional value in reauthorizing an effective, lifelong treatment.
