Lou Portero

Urban Health Today

<div>Optum Rx, a major pharmacy benefit manager (PBM) owned by UnitedHealth, announced on March 19, 2025, that it will eliminate prior authorization requirements for approximately 80 medications, according to <a href="https://www.biopharmadive.com/news/optum-rx-eliminate-prior-authorizations/742964/">BioPharma Dive</a>. Starting May 1, Optum Rx will stop mandating reauthorization for certain drugs already prescribed to patients for chronic conditions like migraines, multiple sclerosis, lung disease, and high cholesterol. This initiative is expected to eliminate up to 25% of all reauthorization requests, equating to a 10% overall reduction in prior authorizations.</div>
<p>Prior authorization has been widely criticized by physicians as burdensome, often delaying patient care, and occasionally leading to severe health consequences. Optum Rx CEO Patrick Conway stated that removing these reauthorizations aims to simplify patient experiences, increase medication access, and reduce administrative tasks for healthcare providers and pharmacists.</p>
<p>The selected medications under the new policy are characterized by their long-term safety profiles, consistent dosing requirements, and established effectiveness. Patients eligible for waived reauthorizations must have confirmed chronic diagnoses and have already considered alternative treatments. Optum Rx indicated the potential expansion of this policy to additional medications in the future, following similar clinical criteria.</p>
<p>This decision by Optum Rx aligns with growing pressure on PBMs and insurers from both healthcare providers and regulators to reduce unnecessary treatment delays caused by administrative hurdles. The industry faces increased scrutiny from lawmakers and antitrust regulators over practices perceived to drive up medication costs. Optum Rx’s recent move may be viewed as an attempt to improve public perception and protect its substantial earnings, which totaled $5.8 billion last year, nearly 20% of UnitedHealth Group&#8217;s operating profit.</p>
<p>In the broader context, major PBMs, including Optum Rx, CVS-owned Caremark, and Cigna-owned Express Scripts, have begun adopting more transparent operating models, responding to client dissatisfaction and regulatory pressures. Optum Rx previously announced plans to phase out practices allowing it to retain drug negotiation savings over the next three years.</p>


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This initiative is expected to eliminate up to 25% of all reauthorization requests

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