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Citing lack of progress, physicians call on Congress to address prior authorization reform

Press releases may be edited for formatting or style | May 14, 2021 Insurance
CHICAGO -- At the height of the COVID-19 pandemic, physicians reported being bedeviled by unnecessary, bureaucratic obstacles that the health insurance industry pledged to reduce three years ago. The data highlights the urgent need for new bipartisan legislation introduced this week in the House, the Improving Seniors' Timely Access to Care Act.

An AMA-conducted survey shows that physicians are running into roadblocks because of prior authorization, or the process of requiring health care professionals to obtain advance approval from health plans before a prescription medication or medical service is delivered to the patient.

The 1,000 practicing physicians surveyed in December 2020—when new COVID-19 cases were soaring — reported that prior authorization was widespread. Eighty-three percent of respondents indicated that prior authorizations for prescription medications and medical services have increased over the past five years. Along with this increased volume of requirements, most physicians reported a continued lack of transparency in prior authorization programs, with a majority of physicians stating that it is difficult to determine whether a prescription medication (68 percent) or medical service (58 percent) requires prior authorization. An overwhelming majority (87 percent) of physicians also reported that prior authorization interferes with continuity of care.

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This grim reality persists despite the fact that three years ago, the AMA and other large health organizations signed a consensus statement that was intended to improve the prior authorization process. The AMA, along with the American Hospital Association, America's Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and the Medical Group Management Association, agreed to reforms needed to reduce prior authorization burdens and enhance patient-centered care.

"You would think insurers would ease bureaucratic demands throughout a pandemic to ensure patients' access to timely, medically necessary care. Sadly, you would be wrong," said AMA President Susan R. Bailey, M.D.

Given the insurance industry's lack of progress in voluntarily reducing the burdens of prior authorization agreed to in the consensus statement, the AMA is calling on Congress to remedy the problem. The Improving Seniors' Timely Access to Care Act (HR 3173) takes direct aim at the insurance industry's foot-dragging and would codify much of the consensus statement.

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