“This move will help correct the imbalance in how pharmacies are paid for brands and generic drugs, and will increase access to medication for patients across the country,” Conway said. Optum said that on average, more refunds will be made for brand prescriptions, the spokesman said that it will be made for more refunds to balance pricing so that pharmacies are encouraged to stock up and distribute all the drugs patients need.
The elimination of up to 25% of re-authorizations, which initially focused on around 80 drugs, accounted for more than 10% of previous authorizations for Optum RX, the company said.
The first drugs include high cholesterol treatments, idiopathic pulmonary fibrosis of lung disease, hypertension, cystic fibrosis, multiple sclerosis, and migraines. The drug has no additional safety risks to patients, and is a long-term treatment, with a dose requirement that is likely to remain constant, the company said.
The company said that medication approval is important for safe use of drugs, and that drugs with safety concerns and those that require surveillance require some reauthorization. For other drugs, such as those that treat cystic fibrosis of genetic symptoms, “there is minimal value added when reapproving effective, lifelong treatments,” the company said.
“These changes mean a simplified system focusing on clinical quality, with easier access to medications for consumers, fewer work for pharmacists and physicians,” Conway said.
