Legislation has been introduced in the House of Representatives to protect patients enrolled in Medicare Advantage plans from prior authorization requirements that needlessly delay or deny access to medically necessary care.
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Prior authorization was intended to control costs by reducing unnecessary tests and procedures, but many health plans now indiscriminately use the process to create nonproductive hurdles for patients and physicians that lead to delays in treatment that may endanger patients’ health. The process for obtaining the required approval can be lengthy and typically requires a physician or member of the care team staff to spend many hours each week negotiating with insurance companies—time that should be spent taking care of patients.
In a recent national survey, 87% of physicians reported that prior authorization has had a significant negative (40%) or somewhat negative (47%) impact on their patients’ clinical outcomes. Nearly a third of physicians surveyed said their patients often abandon treatment due to prior authorization. Furthermore, 84% of survey respondents said the regulatory burdens associated with prior authorization have significantly increased over the past five years, with half of all practices reporting 11 or more requests per week.
The Improving Seniors’ Timely Access to Care Act (H.R. 3173) will require the Centers for Medicare & Medicaid Services (CMS) to regulate the use of prior authorization by Medicare Advantage plans and establish a process to make real-time decisions for services that are routinely approved. Further, the plans would be required to offer a process for electronic prior authorization and to report to CMS how extensively they use prior authorization and how often they approve or deny the relevant medications and services.
Reps. Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Larry Bucshon (R-Ind.) and Ami Bera (D-Calif.) led this important legislation and have been joined by over 100 additional members of Congress to reduce the hurdles between patients and the care they need. Ask your Congressperson to co-sponsor and support H.R. 3173 on behalf of you and your patients today.