HCN News & Notes

AMA Supports Calls for Prior-authorization Reform

CHICAGO — Responding to what is calls unreasonable hurdles for patients seeking care, a coalition including the American Medical Assoc. (AMA) and 16 other healthcare organizations are urging health plans, benefit managers, and others to reform prior-authorization requirements imposed on medical tests, procedures, devices, and drugs.

The coalition, which represents hospitals, medical groups, patients, pharmacists, and physicians, says that requiring pre-approval by insurers before patients can get certain drugs or treatments can delay or interrupt medical services, divert significant resources from patient care, and complicate medical decisions. Concerns that aggressive prior-authorization programs place cost savings ahead of optimal care have led Delaware, Ohio, and Virginia to recently join other states in passing strong patient-protection legislation.

Given the potential barriers that prior authorization can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with a newly created set of 21 principles. Prior authorization programs could be improved, it says, by applying concepts grouped in 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 healthcare resources, and antagonized patients and physicians alike,” said AMA President Dr. Andrew Gurman. “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.”