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Physicians’ Prior Authorization Plea

America’s health care providers have a clear message for Medicare administrators: It’s time to fix prior authorization.

In response to the Centers for Medicare and Medicaid Services’ request for information on administrative health care burdens, the American Medical Association submitted a 28-page letter.  First and foremost, it explains, the agency needs to address prior authorization.  The process requires clinicians to get health plans’ sign-off before patients can get the medication they’re prescribed. 

“We strongly believe that … overall [prior authorization] volume reduction, improved transparency, and continuity of care protections, are needed,” the letter argues.  

It’s not the first time the American Medical Association has expressed concerns.

Last year, the group surveyed physicians and found that 91% say prior authorization delays care, while 75% agree that the hassle leads patients to abandon their medicine.  The findings prompted a consensus statement from the American Medical Association, America’s Health Insurance Plans and the American Hospital Association, among others. The groups aimed to base prior authorization requirements in medical evidence and to use the process more selectively. 

But while health insurers’ trade association may agree reform is necessary, health plans themselves have been slow to implement changes.  Perhaps that’s why the American Medical Association called upon the Centers for Medicare and Medicaid Services to assume a “leadership role” in addressing prior authorization.

The agency has, in fact, prioritized reducing administrative burdens through its “Patients over Paperwork” initiative.  The initiative most recently resulted in the Omnibus Burden Reduction Final Rule – intended to reflect feedback the agency received from its public request for information.  The Centers for Medicare and Medicaid Services expect the rule to eliminate 4.4 million hours of time “previously spent on paperwork,” saving health care providers $800 million a year.

The final rule streamlines requirements for x-ray services, transplant centers and hospices, among other changes.  But it stops short of prior authorization reform. To truly put patients before paperwork, the Centers for Medicare and Medicaid Services may want to heed the American Medical Association’s advice – and turn its attention to ensuring that patients can get timely access to the medications their physicians prescribe.

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