Optum Rx Further Simplifies Consumer Access to Prescription Drugs

Rhea-AI Summary

Optum Rx announces initiatives to simplify prescription drug access and reduce costs for consumers with chronic conditions. The company is eliminating up to 25% of medication reauthorizations, affecting more than 10% of overall pharmacy prior authorizations. The program initially covers approximately 80 drugs, with plans for expansion.

The company highlights several cost-saving tools and achievements:

• Optum Savings IQ helped consumers save $1.3 billion in 2024, reducing average out-of-pocket costs to $5
• Critical Drug Affordability List caps costs for over 290 lifesaving medications, with insulin costs under $18 monthly
• Price Edge tool generated $224 million in consumer savings
• PreCheck MyScript delivers savings of $119 per prescription fill
• MyScript Finder and Proactive Savings Alerts offer additional average savings of $58 and $42 per prescription respectively

Positive

• Elimination of 25% of reauthorizations, streamlining prescription access
• Significant cost savings: $1.3 billion in consumer savings through Savings IQ program
• Price Edge tool generated $224 million in consumer savings
• Substantial per-prescription savings: $119 through PreCheck MyScript
• Affordable insulin program with costs under $18 monthly

Negative

• None.

Insights

Healthcare Policy Analyst

Optum Rx's initiative to eliminate 25% of medication reauthorizations represents a significant operational efficiency gain that addresses a major pain point in healthcare delivery. By focusing initially on 80 drugs for chronic conditions where reauthorization adds minimal clinical value, Optum Rx is implementing a nuanced approach that maintains necessary safety protocols while reducing administrative friction.

The financial impact data is compelling: Optum financial assistance programs generated $1.3 billion in consumer savings in 2024, reducing average out-of-pocket specialty medication costs to just $5. Their Critical Drug Affordability List has driven average insulin costs below $18 monthly. Digital tools like Price Edge ($224 million in savings) and PreCheck MyScript ($119 savings per prescription) demonstrate a multi-pronged strategy for cost containment.

This initiative strategically positions UnitedHealth's PBM business in the ongoing national debate over prescription drug affordability. By streamlining authorization processes, Optum Rx reduces costs across the ecosystem: patients gain faster access to medications, providers face reduced administrative burden, and payers benefit from more efficient resource allocation. The approach of maintaining authorizations where clinically necessary (as with newer Alzheimer's treatments) while eliminating them for established genetic condition therapies represents thoughtful clinical stewardship.

Healthcare Economics Expert

Optum Rx's authorization simplification initiative delivers substantial economic value throughout the healthcare ecosystem. The reduction of 25% of reauthorizations (representing 10% of all pharmacy prior authorizations) creates measurable cost-saving efficiencies for multiple stakeholders.

The initiative's economic benefits extend beyond direct cost savings. Each avoided reauthorization eliminates administrative work for physicians and pharmacists, potentially reducing provider burnout while accelerating medication access. This efficiency gain represents hidden economic value through reduced opportunity costs and improved resource allocation.

The suite of consumer-focused savings tools demonstrates sophisticated price optimization technology. PreCheck MyScript generates dual economic benefits: $119 consumer savings per prescription plus $266 client savings. Their Price Edge tool's $224 million in consumer savings strengthens UnitedHealth's value proposition in an increasingly competitive PBM landscape.

For UnitedHealth, these initiatives create strategic leverage in pharmaceutical manufacturer negotiations. By demonstrating commitment to consumer affordability while maintaining appropriate clinical oversight, Optum Rx positions itself as a rational actor in drug pricing conversations. The Critical Drug Affordability List specifically addresses high-visibility medications like insulin, potentially improving both consumer satisfaction metrics and UnitedHealth's reputation among policymakers focused on drug pricing reform.

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:

1. 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.
2. 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.
3. Price Edge, a digital price comparison tool that has generated $224 million in consumer savings, with an average savings of $50 per consumer.
4. 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.
5. Proactive Savings Alerts, which notifies consumers of savings opportunities averaging $42 per prescription.
6. 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.

About Optum

Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 210,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group. For more information, visit www.Optum.com.

View source version on businesswire.com: https://www.businesswire.com/news/home/20250319970580/en/

Media Contact: newsroom@optum.com

Source: Optum Rx

FAQ

How much will Optum Rx's new authorization policy reduce pharmacy prior authorizations?

The policy will eliminate up to 25% of reauthorizations, equivalent to more than 10% of overall pharmacy prior authorizations.

What are the consumer savings achieved through Optum Rx's Savings IQ program in 2024?

Optum Savings IQ helped eligible consumers save $1.3 billion in 2024, reducing average out-of-pocket costs to $5.

How much do patients pay for insulin under Optum Rx's Critical Drug Affordability List?

Patients pay less than $18 per month on average for insulin under the Critical Drug Affordability List program.

What are the average savings per prescription through Optum Rx's PreCheck MyScript tool?

PreCheck MyScript generates consumer savings of $119 per prescription fill and client savings of $266.