AMA leads health care coalition calling for reform of prior authorization programs

The AMA, along with 16 other health care organizations, recently called for the reform of insurer pre-approval requirements for medical tests, procedures, devices and drugs because such prior authorization can delay or interrupt medical services, jeopardize patient-centered care and complicate medical decisions, according to a recent news release.

To improve current prior authorization programs, the coalition is imploring for an industry-wide reassessment of the programs to support 21 new principles that are based on five broad categories: clinical validity, continuity of care, transparency and fairness, timely access and administrative efficiency and alternatives and exemptions.

“Strict or bureaucratic oversight programs for drug or medical treatments have delayed access to necessary care, wasted limited health care resources and antagonized patients and physicians alike,” Andrew W. Gurman, MD, president of AMA, said in a press release. “The AMA joins the other coalition organizations in urging health insurers and others to apply the reform principles and streamline requirements, lengthy assessments and inconsistent rules in current prior authorization programs.”

An average of 37 prior authorization requirements per physician are completed every week by the physician and their staff, which takes an average of 16 hours or 2 business days to process, thus reducing time available for patients, according to a new AMA survey.

The survey also demonstrated that of the participating physicians, 75% reported prior authorization burdens as high or extremely high and more than a third had staff who exclusively work on prior authorizations. In addition, approximately 60% reported that on average, their practices wait at least 1 business day for prior authorizations to be made by insurers, with more than 25% waiting 3 business days or longer. The survey also revealed that approximately 90% believed that prior authorization sometimes, often or always delays access to care.

According to the AMA, its survey results suggest that “there is a real opportunity to improve the patient experience while significantly reducing administrative burdens for both payers and physicians by reforming prior authorization and utilization management programs.”

For more information:

https://www.ama-assn.org/health-care-coalition-calls-prior-authorization-reform

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.