Optum Rx Expands Prior Authorization Reduction Initiatives, Surpassing Initial Goals

Optum Rx, the pharmacy benefit management arm of UnitedHealth Group, has announced significant expansions to its prior authorization reduction initiatives, exceeding its original targets set earlier this year. The company will implement these changes starting January 1, 2026, marking a substantial shift in how medication approvals are handled for millions of patients.

Reauthorization Reductions Surpass 25% Goal

Optum Rx revealed plans to reduce reauthorizations on an additional 40 medications, bringing the total number of drugs included in this initiative to 180. This expansion surpasses the company's initial goal of reducing reauthorizations by up to 25%, as announced earlier this year.

The new group of 40 medications encompasses therapies for chronic conditions and introduces two new classes of drugs to the program: hormone therapy and injectables for knee osteoarthritis. This broadened scope reflects Optum Rx's commitment to streamlining the approval process across a wider range of treatment areas.

PreCheck Prior Authorization Program Expansion

In addition to the reauthorization reductions, Optum Rx is significantly expanding its PreCheck Prior Authorization program. Starting January 1, the program will cover more than 45 medications and reach 20 health systems. This automated tool has shown impressive results in reducing approval wait times and improving efficiency.

Key features of the PreCheck program include:

• Reduction in determination wait times from 8.5 hours to approximately 30 seconds
• Faster approvals for about 75,000 physicians
• Potential for approvals before patients leave the doctor's office or reach the pharmacy counter

Dr. Eric Boose, Associate Chief Medical Information Officer at Cleveland Clinic, praised the program's efficacy: "It's amazing to take what is already there in the chart to automate prior authorization without any additional effort from the physician, pharmacists or staff. I feel the promise and excitement of automation actually happening and working and hope it grows quickly."

Pilot Program Success at Cleveland Clinic

Optum Rx's pilot of the PreCheck tool with Cleveland Clinic has yielded remarkable results:

• 100% accuracy after one year of implementation
• 67% automation rate
• 88% reduction in appeals

These outcomes demonstrate the potential for significant improvements in the prior authorization process, benefiting healthcare providers, pharmacists, and patients alike.