UnitedHealth’s Optum to address pricing, access challenges for prescription drugs

Optum — UnitedHealth Group’s division that controls one of the nation’s largest pharmacy benefit managers — is moving to improve access and pricing for prescription drugs by cutting some reauthorizations and changing the way it pays pharmacies.

The Eden Prairie-based corporate sibling of insurance giant UnitedHealthcare said Wednesday that it will eliminate up to 25% of prescription drug reauthorizations that require medicines to be reapproved for use. On Thursday, Optum said in a news release it is aligning its payment models to account for high-cost branded drugs “entering the market, raising costs for pharmacies.”

The policy changes come as UnitedHealth Group faces scrutiny for the ways it requires doctors and patients to seek its approval to access certain treatments. Some critics have alleged pharmacy benefit managers like Optum are ballooning drug costs while running independent pharmacies out of business.

Optum said the two actions this week respond to increasing drug prices set by pharmaceutical companies.

“Optum Rx is taking meaningful steps to simplify patient experiences and increase access to critical medications,” said Dr. Patrick Conway, chief executive of benefit manager Optum Rx, in a news release.

A Federal Trade Commission study last year found pharmacy benefit managers such as Optum may have inflated drug costs while squeezing independent pharmacies. The trade group for the companies countered that the report “falls far short of being a definitive, fact-based assessment.”

The company said the change to pharmacy payment models comes as pharmacies across the country are paying more for many drugs.

The changes, which the company said it will fully implement by January 2028, will align Optum Rx’s payment models more closely to costs pharmacies may face due to drug manufacturers' actions. It adjusts a model originally designed to promote the use of generic drugs by accounting for higher-cost branded drugs entering the market.

“This move will help correct imbalances in how pharmacies are paid for brand and generic drugs and will ensure greater access to medicines for patients across the country,” Conway said. Optum will reimburse more on average for brand prescriptions, a spokesperson said, to balance pricing so pharmacies are incentivized to stock and distribute all drugs patients need.

The elimination of up to 25% of reauthorizations, focusing first on approximately 80 drugs, makes up more than 10% of Optum Rx’s prior authorizations, the company said.

The initial drugs include medication treating high cholesterol, lung disease idiopathic pulmonary fibrosis, high blood pressure, cystic fibrosis, multiple sclerosis, and migraines. The medicines have no additional safety risk for patients, are long-term treatments, and have dose requirements that are likely to remain constant, the company said.

The company said medication authorizations are importance for the safe use of drugs, and some reauthorizations are necessary for drugs with safety concerns or that require monitoring. For other drugs, like those treating genetic condition cystic fibrosis, “there is minimal additional value in reauthorizing an effective, lifelong treatment,” the company said.

“These changes mean easier access to medications for consumers, less work for pharmacists and physicians, and a simplified system focused on clinical quality,” Conway said.