Optum Rx Eliminates Reauthorization on an Additional 60 Drugs

Effective July 1, 2025, Optum Rx is removing reauthorization for more than 60 drugs that treat chronic conditions. The newly added medications include treatments for seven chronic conditions, such as behavioral health, HIV, dry eye disease, high cholesterol and hypertension.

Sumit Dutta, M.D.

“Chronic conditions affect about 60% of Americans and are the leading cause of death in the United States,” Sumit Dutta, M.D., chief medical officer, Optum Rx, said in a news release. “Eliminating reauthorization requirements for established and effective treatments underscores our commitment to make these needed drugs more accessible, which also supports better health outcomes.”

The new reauthorization eliminations will apply to seven therapeutic categories that treat these chronic conditions:

• Anticonvulsants: Briviact, Xcopri, Motpoly XR, Oxtellar XR, oxcarbazepine ER, Qudexy XR, Trokendi XR, Topiramate ER capsules, Eprontia, Elepsia XR

• Antidepressants: Aplenzin, Forfivo XL, Bupropion XL 450 mg, Fetzima, Citalopram capsules, Desvenlafaxine ER, Drizalma, Paxil suspension, Sertraline capsules, Trintellix, Venlafaxine tab 112.5 mg, Auvelity, Viibryd

• Antipsychotics: Caplyta, Cobenfy, Fanapt, Lybalvi, Opipza, Saphris, Secuado, Invega Hafyera

• Antihypertensives: Kapspargo, Edarbi, Edarbyclor, Tekturna HCT, Exforge HCT

• High Cholesterol: Evkeeza, Altoprev, Ezallor, Flolipid, Lescol XL, Lipitor, Livalo, Zocor, Roszet, Ezetimibe-rosuvastatin, Zypitamag, Fenoglide, Fibricor

• HIV: Descovy, Truvada, Vocabria, Selzentry, Sunlenca

• Dry Eye Disease Agents: Cequa, Eysuvis, Miebo, Restasis, cyclosporine ophthalmic emulsion, Tyrvaya, Vevye, Xiidra

An Optum Rx spokesperson said the PBM is building on a commitment made in March 2025 to remove reauthorizations on certain chronic treatments to make prescription drugs more accessible and support better health outcomes. “By eliminating reauthorizations for more than 140 drugs, Optum Rx drives continuity of care for patients, provides a simpler experience for those with chronic diseases, and reduces administrative burden for providers and pharmacists,” the spokesperson said.

Related: Optum Rx Ends Reauthorization for Many Chronic Disease Drugs

In March, Optum Rx announced that it eliminated reauthorization on almost 70 drugs for chronic diseases, which the company said is equal to more than 10% of overall pharmacy prior authorizations.

For the newer drugs removed from reauthorization, Optum Rx’s clinical team applied the same criteria used in March to choose. The drugs were approved by Optum Rx’s independent Pharmacy & Therapeutics Committee.

Optum Rx, the pharmacy benefit manager of UnitedHealth Group, saw revenue in 2024 increase by 15%, according to the company’s earnings release in January 2025. The number of adjusted scripts grew to 1.62 billion, compared with 1.54 billion in 2023. In a call with investors in January, company officials vowed to reduce the prior authorization burden and to work on speeding up turnaround times for procedures and services in Medicare Advantage plans.

Related: Plans Agree to Prior Auth Reform. Physicians and Business Groups Want Measurable Results

Health plans have been facing significant and very public pressure around their policies on the utilization management tactic that they say is necessary to ensure their members’ care is safe, effective, evidence-based and affordable. Last week, more than 50 insurers, including United Healthcare, pledged to streamline and simplify the prior authorization process through six new commitments.

Health plans have said that prior authorization reduces the costs of expensive treatments and improves care. Officials from the American Medical Association, however, point to a 2021 study published in Health Affairs that found prior authorization instead adds costs to healthcare. This study, which focused on prior authorization for prescription drugs, found that payers, manufacturers, physicians, and patients together spend approximately $93.3 billion annually on implementing, contesting, and navigating utilization management.