Anne Mall, M.H.A., on automating prior authorization approval requests | PBMI 2026

Optum Rx's automated prior authorization tool, PreCheck Prior Authorization, is automating almost two-thirds of approved prior authorizations in under 30 seconds using data already documented in a provider's electronic health record, according to Anne Mall, MHA, vice president of capabilities at Optum Rx.

PreCheck Prior Authorization works upstream of Optum Rx’s other AI capabilities, operating within the provider’s workflow at the point when a prescription is written, Mall said in an interview last week with Managed Healthcare Executive at the 2026 Pharmacy Benefit Management Institute (PBMI) Annual National Conference in Orlando, Florida.

The tool uses discrete data elements already in the EHR, such as diagnosis codes, to automate the prior authorization request before the prescription reaches the pharmacy. It is used for approvals only, Mall emphasized, with denials still routed to a clinician for review.

Optum Rx announced the launch of Precheck Prior Authorization in October 2024.

The automation is getting patients onto therapy four days faster, Mall told MHE. 

The remaining approvals, in which supporting documentation can’t be located in the EHR within roughly 30 seconds, are routed to a clinician who looks for that additional documentation, she explained. A case that isn't automated isn't denied, Mall noted; it simply moves to a person for review. Optum Rx's near-term goal is to push the automation rate to 80%, though Mall said some prior authorizations — the most complex cases — will likely always require a clinician's judgment.

Optum Rx, a pharmacy benefit manager, is part of UnitedHealth Group. The health insurance arm of UnitedHealth Group, UnitedHealthcare, announced earlier this month that it will eliminate 30% of prior authorization in its commercial and Medicare Advantage plans.

Prior authorization, a key tool of insurers for managing the cost of care, has been a controversial topic in U.S. healthcare, with providers and many patient groups saying it unnecessarily slows the delivery of healthcare. UnitedHealth Group has been on the receiving end of some of the most pointed criticism and scrutiny. For example, a report by the HHS Office of Inspector General in June 2026 found that UnitedHealth Group, along with CVS and Humana, was more likely to deny prior authorization requests for long-term acute care and inpatient rehabilitation than other Medicare Advantage organizations.