The ACR has partnered with the American Medical Association (AMA) and over a dozen stakeholder groups to create a set of 21 principles to reform prior authorization protocols. This coalition represents hospitals, medical groups, patients, pharmacists and physicians with a unified goal of creating a more patient-centered, streamlined and transparent process for prior authorization.
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Explore This IssueMarch 2017
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According to a new AMA survey, every week a medical practice completes an average of 37 prior authorization requirements per physician, which takes a physician and their staff an average of 16 hours, or the equivalent of two business days, to process. More than a third of surveyed physicians reported having staff who work exclusively on prior authorization, and nearly 90% of surveyed physicians reported that prior authorization sometimes, often or always delays access to care.
Prior authorization is more than an administrative burden that can take providers away from their patients. When preapproval is required by insurers before patients can access certain drugs or treatments, it can harm patients by delaying or interrupting needed medical services.
Utilization review entities should offer a minimum of a 60-day grace period for any step therapy or prior authorization protocols for patients who are already stabilized on a particular treatment upon enrollment in the plan.
Further, no utilization review entity should require patients to repeat step therapy protocols or retry therapies failed under other benefit plans before qualifying for coverage of a current effective therapy.
These reform principles seek common sense solutions that call for guidelines based on clinical criteria and patient safety, not cost alone. View all 21 principles. You can help the ACR promote prior authorization reform by becoming a key contact. Learn more.