Insurer Inaction Called on Previous Authorization Reform – AMA

Insurer Inaction Called on Previous Authorization Reform – AMA

Dive Brief:

  • The American Medical Association says it is fed up with stalled efforts to revamp patient prior authorization requirements. The lobbying group is now pushing a legislative fix — pointing to a bipartisan bill introduced last year — after trying to craft a solution with payers.


  • AMA found that 29% of physicians spend at least three days waiting on insurers for a prior authorization response and 91% reported it resulted in a delay in necessary care, according to a survey of 1,000 practicing physicians that was conducted in December.


  • The survey, released Tuesday, showed physicians and their offices spend a significant amount of time and resources on prior authorizations. Almost one-third of physicians have staff members who work exclusively on prior authorization issues.


Dive Insight:


AMA’s push for a change to prior authorizations requirements comes after it last year reached a consensus with payers and other industry groups to work together on reforms.


In 2018, America’s Health Insurance Plans, the Blue Cross Blue Shield Association, AMA and the American Hospital Association, among others, drafted a consensus on prior authorization, vowing to work together to find ways to reduce administrative burden and streamline the process for providers.


At the time, the groups outlined five areas ripe for improvement, which included supporting a selective application of prior authorization use, regular review of services and drugs subject to prior authorization, and transparency around such programs.


However, on Tuesday, AMA said those efforts have stalled. The survey showed 86% of respondents saying the burden associated with prior authorization has increased over the past five years.

The bill AMA is touting would require Medicare Advantage plans to establish an electronic prior authorization program and publish information on percentage of requests approved and average response time among other stipulations.


AHIP has defended the use of prior authorization in the past, arguing it can limit misuse of care, protect patients and improve quality. The payer lobby in January launched an initiative to speed up the transition to electronic prior authorization.


AMA’s survey found that nearly a quarter of physicians said prior authorization had led to a serious or adverse event and 16% said it led to a patient’s hospitalization. Nearly three quarters said it can sometimes lead to the abandonment of treatment.

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