Optum Rx Eases Insurance Reauthorizations for 80 Key Drugs

Optum Rx is changing how consumers access prescription drugs, especially for those with chronic conditions.

On March 19, 2025, the company announced that will eliminate up to 25% of reauthorizations — a process that confirms a medication is safe and effective before it is dispensed, with reauthorizations serving as follow-up approvals.

The company is initially targeting roughly 80 key drugs and plans to expand this list over time, working closely with physicians and pharmacists to ensure that patients receive their medications without unnecessary administrative delays.

Optum Rx’s current suite of cost-lowering tools range from financial assistance programs like Optum Savings IQ to digital tools such as the Critical Drug Affordability List, Price Edge, PreCheck MyScript, Proactive Savings Alerts and MyScript Finder.

In the US, retail prescription drug spending reached $406 billion net of rebates in 2022, with per capita spending at $1,227. Meanwhile, more than 4,200 drugs experienced average list price increases of 15.2% from January 2022 to January 2023 — with 46% of these hikes exceeding the rate of general inflation.

Based on 2022 data estimates, US drug prices were on average 2.78 times higher than prices in 33 other countries. A Kaiser Family Foundation report found that 28% of adults struggle to afford their prescription drugs, with the burden falling hardest on those who take multiple medications and those with lower incomes. Among people on four or more medications, 37% report affordability issues, compared to 18% for those taking one to three medications.

So it doesn’t come as a surprise to find that three in 10 US adults report not taking their prescriptions as directed due to cost concerns.

How Optum Rx and Others are Improving Their Payment Models

In recent years other major players have also launched innovative programs to tackle high drug costs.

Blue Shield of California introduced “Pharmacy Care Reimagined,” a model that partners with Amazon Pharmacy, cost-transparent generics and value-based negotiators to save up to $500 million annually.

Amazon Pharmacy’s RxPass subscription service offers eligible generics for a flat $5 monthly fee, providing a predictable and affordable option for many patients.

Additionally, in 2023 nonprofit manufacturer Civica Rx worked to slash insulin prices by as much as 90%. More recently, Cost Plus Drug Company reported average consumer savings of up to 60% — about $50 per prescription fill.

In this environment, Optum Rx’s move to improve consumer access could pave the way for a more patient-focused pharmacy system.

Optum Rx is also modernizing its payment models. Set for full implementation by January 2028, these changes will align reimbursements with the actual costs pharmacies incur, benefiting over 24,000 independent community pharmacies. By doing so, Optum hopes to increase financial stability, keep pharmacy shelves stocked and minimize drug shortages.