Optum Rx, the pharmacy benefit manager under UnitedHealth Group, is set to eliminate prior authorization requirements for approximately 80 prescription drugs in an effort to simplify access to medications for patients with chronic conditions.
The changes are expected to reduce prior authorizations by 25%, representing more than 10% of all prior authorizations across its pharmacy network, according to a March 19 news release from the company.
The move is a part of a broader initiative by UnitedHealth Group to cut back on prior authorization requirements. In 2023, the company eliminated 20% of prior authorization requirements and in 2024, introduced a gold card program, which allows certain providers to skip prior authorization for specific services.
In addition, starting April 1, Optum Home & Community Care, formerly known as NaviHealth, will eliminate prior authorizations for home health services, applying to Medicare Advantage and dual special needs plans in more than 30 states.
UnitedHealthcare’s prior authorization policies have come under scrutiny in the past. In 2023, the families of two deceased UnitedHealthcare Medicare Advantage members sued the insurance company, alleging that an AI tool developed by NaviHealth was used to wrongfully deny post-acute care.
In January 2024, the company rebranded NaviHealth into Optum Home & Community Care, now a part of Optum.
