AMA pushes for federal intervention to reform prior authorization

Docs say health plans have made little progress toward streamlining prior authorization—despite pledging to do so two years ago.

Because payers are dragging their feet, federal lawmakers should step in and force change, the American Medical Association (AMA) said in a statement.

"Almost two and a half years after our consensus statement, the sad fact is little progress has been made toward the reform goals," said AMA President Susan Bailey, M.D. "The health insurance industry’s failure to achieve agreed-upon improvements illustrates a clear need for legislation … to rein in prior authorization practices that adversely affect patient health."

As part of the 2018 consensus statement, which both America's Health Insurance Plans and the Blue Cross Blue Shield Association signed on to, health plans said they would reduce the number of healthcare professionals subject to prior authorization as well as review medications and other therapies routinely.

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The AMA also released survey data it says highlight just how little progress has been made in the past two years.

For instance, 24% of 1,000 physicians surveyed said waiting on prior authorization has led to a serious adverse event for a patient. Sixteen percent said it led a patient to be hospitalized.

The vast majority (91%) said prior authorization led to notable delays in care.

As such, the AMA is pushing legislators to take up the Improving Seniors' Timely Access to Care Act, a House bill that would nationally codify much of what was outlined in the consensus statement.

The bill has bipartisan backing in the House.

“My legislation will go a long way in addressing what this survey makes clear—physicians and other health care professionals are spending too much of their time dealing with burdensome and archaic prior authorization requests when they should be caring for people,” said Rep. Suzan DelBene, D-Washington, one of the bill's sponsors, in a statement.