By Sriparna Roy and Amina Niasse
(Reuters) -UnitedHealth Group’s pharmacy benefit manager, Optum Rx, said on Wednesday it would ease requirements to get insurance authorization when renewing prescriptions on about 80 drugs, aiming to reduce paperwork for patients and doctors.
The list, which could be expanded over time, will eliminate up to 25% of reauthorization requirements and accounts for more than 10% of all such pharmacy authorizations, it said.
The program starts on May 1 and will include drugs ranging from Amgen’s migraine treatment Aimovig, Vertex Pharmaceutical’s cystic fibrosis treatment Kalydeco, and Regeneron’s Praluent for high cholesterol.
“We put a clinical lens on this. For these drugs, adherence over time is the major benefit,” said Patrick Conway, CEO of Optum Rx. “You want patients to maintain their cystic fibrosis, asthma and diabetes drug because it maintains their health and their total cost of care.”
The killing of a UnitedHealth executive last December had set off an outpouring of complaints about insurance on social media, including UnitedHealthcare and other insurers’ requirements to seek their approval on medicines and medical services.
In January this year, UnitedHealth said during a conference call with investors that it would work with policymakers to reduce the frequency of prior authorizations required before a patient can access medical treatment in its Medicare business for people aged 65 and older or with disabilities.
Reauthorizations, or certain checks that patients need to go through to continue receiving their medications, are necessary for drugs that have safety concerns, or need ongoing monitoring for adjusting doses, or additional tests, UnitedHealth’s unit said.
Newly approved drugs for diseases such as Alzheimer’s require ongoing review, whereas with genetic conditions like cystic fibrosis, there is minimal additional value in reauthorizing a treatment, the company said.
In an interview with Reuters, Conway said he expected the change to be received positively by lawmakers, who scrutinized prior authorization practices in state and federal legislatures last year.
However, Robert Popovian, founder of healthcare consultancy Conquest Advisors, said the program’s emphasis on reauthorization is too narrow to reduce the administrative burden of prior authorizations across medical services.
Pharmacy benefit managers negotiate drug prices and create coverage lists for health plans, mainly for employers and the government. They pay pharmacies directly for prescription drugs under their agreed terms.
CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum control the majority of the U.S. pharmacy benefit market, with their parent companies also operating health insurance and pharmacy businesses.
They have come under scrutiny for their role in driving up costs for drugs. President Donald Trump has also said he wants to knock out these middlemen.
(Reporting by Sriparna Roy in Bengaluru; Editing by Shilpi Majumdar and Nia Williams)
