Optum Rx continues to improve the pharmacy prior authorization experience
November 24, 2025 | 2-minute read
The big picture
On Jan. 1, 2026, Optum Rx will reduce reauthorizations for an additional 40 drugs. This expands on efforts started earlier this year to eliminate reauthorizations for chronic condition medications, and adds two new drug classes – hormone therapy and knee osteoarthritis injectables.
Optum Rx will continue working with physicians and pharmacists to reduce reauthorizations for even more medications.
There are now 180 medications with reduced reauthorization, surpassing the initial goal of a 25% reduction in reauthorizations.
What’s more: Optum Rx is expanding PreCheck Prior Authorization*, its industry-first solution that automates the creation and approval of prior authorizations, reducing approval time from 8.5 hours to under 30 seconds. By Jan. 1, 2026, PreCheck Prior Authorization will cover more than 45 medications and reach 20 health systems, driving faster approvals for 75,000 physicians and helping patients get their medication faster. With the expansion, even more patients will have their prior authorization approved before going to the pharmacy and, in some cases, before leaving their appointment.
The results speak for themselves. In partnership with Cleveland Clinic, PreCheck Prior Authorization had 100% accuracy after one year, delivered a 67% automation rate and cut appeals by 88%, making health care simpler.
The bottom line: Optum Rx continues making pharmacy care better and more innovative, with an unwavering commitment to quality. This commitment is further demonstrated by earning reaccreditation from the National Committee for Quality Assurance (NCQA) in Utilization Management, reflecting the dedication of Optum Rx to clinical quality and operational integrity, including prior authorization, ensuring coverage decisions remain appropriate and evidence based.
Dig deeper
Read more about how Optum Rx is transforming pharmacy care.
NCQA has reviewed and accredited Optum Rx’s Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.
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*Prior authorization criteria not able to be approved through automation are sent to the provider to enter manually. Clinical staff makes the final determination when denial of coverage occurs in prior authorization.