Optum Rx is committed to making prescription drugs more affordable and the pharmacy experience simpler for consumers with chronic conditions, 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 Patrick Conway, M.D., chief executive officer, Optum Rx. “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 Optum Rx 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.
Fighting to Lower Drug Costs: What We’ve Done for Consumers
In addition to the initiative announced today, Optum Rx continues to fight the high and ever-increasing drug prices set by pharmaceutical companies through both negotiation and innovative, cost-cutting tools such as:
- Optum financial assistance programs, including Optum Savings IQ, which matches eligible Optum Specialty patients with financial resources and programs to lower their out-of-pocket costs for specialty medications. In 2024, the programs helped eligible consumers save $1.3 billion and reduced the average out-of-pocket cost to $5.
- Critical Drug Affordability List, which caps out-of-pocket costs for people on over 290 lifesaving medications; our consumers now pay less than $18 per month on average for insulin and typically $5 or less for most drugs.
- Price Edge, a digital price comparison tool that has generated $224 million in consumer savings, with an average savings of $50 per consumer.
- PreCheck MyScript, which automatically scans drug prices to provide real-time price information and ensure consumers get the best price for their medications, generating consumer savings of $119 per prescription fill and client savings of $266.
- Proactive Savings Alerts, which notifies consumers of savings opportunities averaging $42 per prescription.
- MyScript Finder, which averages $58 in savings when used, enables consumers to see the price of their prescribed medication, as well as the pharmacies and medication alternatives that could save them money.
