As a result of those discussions, the AMA, along with the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association, released the Consensus Statement on Improving the Prior Authorization Process in January 2018. This document reflects agreement between provider and health plan organizations to pursue PA reform in several key areas, including reduction in the overall volume of PAs, improved transparency and communication, protection of continuity of care and automation to increase process efficiency.
State legislative efforts also play a critical role in the AMA’s campaign to improve PA processes, and the AMA is working with state and specialty societies to enact legislation. The AMA offers model legislation that continues to serve as the basis for many of the state bills and provides resources and support for these efforts. This year alone, more than 20 states are addressing utilization management reform in their legislatures. (See “Arkansas PBM Bill Offers Transparency.”)
At the federal level, the ACR, working with a coalition of other physician organizations, recently sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma. The letter discussed one of the top administrative burdens under Medicare—PA requirements of Medicare Advantage Organizations (MAOs). The signed organizations strongly believe that CMS guidance and oversight in this area are timely and necessary to reduce unnecessary administrative burdens and to maintain patient access to care. The ACR, along with coalition colleagues, has also met with the CMS on increased oversight and issuing guidance to MAO plans on the appropriate uses of PA. The ACR has been an active participant in meetings on Capitol Hill to educate Congress on the overuse of PAs by MAO plans.
The ACR is also working to advance the Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018 (H.R. 4841), which would streamline and reduce delays for prior authorization approval in Medicare by requiring the CMS to provide for the development of an electronic prior authorization (ePA) standard for Part D and Medicare Advantage plans.
We encourage you to use the PA survey results in your advocacy efforts on this important issue. The survey results, along with a variety of other PA advocacy and educational resources, are available at ama-assn.org/prior-auth. If you have an ongoing prior authorization issue on which you would like the ACR to assist, write to [email protected].
