Medical groups endorse legislation to reform prior authorization

The AMA and other professional organizations endorsed the Improving Seniors’ Timely Access to Care Act, which would streamline prior authorizations for Medicare Advantage plans and introduce additional protections for patients.

The AMA’s endorsement coincides with the release of its December 2020 survey, in which 83% of member-respondents reported that prior authorizations for medications and medical services have increased over the previous 5 years and 87% reported that prior authorizations interfere with continuity of care, according to a press release.

In addition, of the 1,000 practicing physicians who responded to the AMA survey, most said that prior authorization programs continue to lack transparency. Sixty-eight percent of physicians said it is hard to determine whether a prescription medication requires prior authorization, and 58% said the same about medical services.

“You would think insurers would ease bureaucratic demands throughout a pandemic to ensure patients’ access to timely, medically necessary care,” Susan R. Bailey, MD, AMA president, said in the release. “Sadly, you would be wrong.”

Rep. Suzan K. DelBene (D-Wash.) introduced the legislation to the House of Representatives on May 13 and it was referred to the House Committee on Ways and Means as well as the committee on Energy and Commerce. The next step for the bill is to pass a vote in the House.

According to the AMA, the Improving Seniors’ Timely Access to Care Act would:

• streamline the prior authorization process for Medicare Advantage plans;
• require more transparency for beneficiaries and health care providers;
• give CMS more oversight on prior authorization processes;
• allow real-time decisions for certain prior authorization requests; and
• require Medicare Advantage plans to meet beneficiary protection standards, including ensured continuity of care for patients who change plans.

In addition to the AMA, the Regulatory Relief Coalition also announced its support of the bill. The coalition’s membership is comprised of professional organizations spanning multiple disciplines within health care, including the American Academy of Family Physicians, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Orthopaedic Surgeons, American College of Cardiology, American College of Rheumatology, American Gastroenterological Association, American Osteopathic Association and the Association for Clinical Oncology, according to its website.

DelBene first introduced the legislation to the previous Congress in 2019. It was then referred to the House Subcommittee on Health but did not progress to a vote. The 2019 bill was endorsed by 370 professional organizations in a letter to Congress, including the AAFP, ACP and AMA.

“There is no room in the patient-physician relationship for insurance-industry barriers,” Bailey said in the release. “The AMA is dedicated to simplifying and right-sizing prior authorization so physicians can properly provide care and patients can receive the timely treatment they deserve.”

References:

• 116th Congress. H.R.3107 - Improving Seniors' Timely Access to Care Act of 2019. Accessed May 17, 2021. Available at: https://www.congress.gov/bill/116th-congress/house-bill/3107.
• 117th Congress. H.R.3173 - To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes. Accessed May 17, 2021. Available at: https://www.congress.gov/bill/117th-congress/house-bill/3173?q=%7B%22search%22%3A%5B%22HR+3173%22%5D%7D&s=2&r=1.
• American College of Cardiology. ACC-Supported Prior Authorization Reform Legislation Reintroduced in Congress. Accessed May 17, 2021. Available at: https://www.acc.org/Latest-in-Cardiology/Articles/2021/05/13/17/36/ACC-Supported-Prior-Authorization-Reform.
• American College of Physicians. Letter to Congress. Accessed May 17, 2021. Available at: https://www.acponline.org/acp_policy/letters/improving_seniors_timely_access_to_care_act_2019.pdf.
• American Medical Association. Physicians call on Congress to address prior authorization reform. Accessed May 17, 2021. Available at: https://www.ama-assn.org/press-center/press-releases/physicians-call-congress-address-prior-authorization-reform.
• Regulatory Relief Coalition. Accessed May 17, 2021. Available at: https://www.regrelief.org/.