Search

Administrative Burden

Insurance requirements like prior authorization and step therapy force patients to delay or abandon necessary eye care. The Academy is fighting against these harmful policies.

A doctor wearing blue scrubs stands at a desk and writes on a pad of paper

Insurance companies increasingly stand between ophthalmologists and their patients. Prior authorization requirements force physicians to obtain insurer approval before delivering care that has already been deemed medically necessary — delaying treatment, consuming physician and staff time, and in some cases causing serious patient harm. Step therapy policies, also called "fail first" requirements, compel patients to try and fail on insurer-preferred drugs or treatments before accessing the care their physician has prescribed. 

Together, these policies represent some of the most significant administrative burdens facing ophthalmology practices today. They are not clinically neutral: delays in treating conditions like age-related macular degeneration, glaucoma, and diabetic eye disease can result in permanent, irreversible vision loss. 

The Academy has worked for years through legislation, regulation, and coalition advocacy to reform these policies and restore clinical decision-making authority to physicians and their patients.

Prior Authorization

Health insurers require physicians to obtain pre-approval for treatments and tests, delaying patient care and burdening ophthalmology practices. 

Step Therapy

"Fail first" policies force patients to try insurers' preferred drugs before accessing the treatments their physicians recommend.

Know Our Issues

These are the issues threatening ophthalmology and putting patient health at risk.

Take Action on Administrative Burden

Prior authorization and step therapy are harming your patients and burdening your practice. Congress can act — but only if physicians speak up.

Contact Congress

Latest News

See All Administrative Burden News
Member exclusive Fallback image

CMS Tests Prior Authorization for Some ASC Services

The Centers for Medicare & Medicaid Services (CMS) has introduced a new pilot program requiring prior authorization (PA) for fee-for-service Medicare for certain services in ambulatory surgical centers (ASCs).

Member exclusive Fallback image

Advocacy Works: CMS Delays ASC Prior Authorization Pilot

With the help of the American Society of Ophthalmic Plastic and Reconstructive Surgery, the Outpatient Ophthalmic Surgery Society, and the North American Neuro-Ophthalmology Society, the Academy has persuaded the Centers for Medicare & Medicaid Services (CMS) to delay the start of the prior authorization (PA) pilot in ambulatory surgical centers.

Member exclusive Fallback image

Ophthalmology Coalition Pushes Back on CMS ASC Prior Authorization Pilot

The Academy is pushing for a delay in implementation for the pilot, scheduled to start on Dec. 15.

Our Advocacy in Action

The Academy continues to lead efforts to reduce administrative barriers that delay patient care and burden ophthalmology practices — securing regulatory wins and insurer corrections that directly benefit patients and physicians. 

Learn More About Our Impact
A doctor wearing blue scrubs stands at a desk and writes on a pad of paper
Capitol Hill icon
Bipartisan
The Academy secured introduction of bipartisan prior authorization reform legislation with broad support across Congress and national health organizations.
US map icon
Extensive
1.8 million wrongfully denied claims successfully pushed for reprocessing by Humana, restoring access and reimbursement for patients and physicians.
Megaphone icon
Ongoing
The Academy's Regulatory Relief Coalition continues to press Congress and CMS to end prior authorization delays across Medicare Advantage plans.

Join Us in Protecting the Future of Eye Care

Every contribution strengthens our impact.

Ophthalmologists advocating on Capitol Hill in Washington, D.C.

OPHTHPAC

The Academy’s political action committee, OPHTHPAC, advocates at the federal level for our members and the patients they treat on critical issues affecting ophthalmology.
Donate Now
Three ophthalmologist eye surgeons in an operating room

Surgical Scope Fund

Help derail dangerous scope of practice expansion initiatives at the state level that put patient safety at risk by supporting the Surgical Scope Fund.
Donate Now