• Prior Authorization

  • Background

    Prior authorization is a burdensome process that requires physicians to get insurer pre-approval for medical treatments or tests before giving care to their patients. Health insurers frequently require prior authorization for pharmaceuticals, durable medical equipment and medical services. The process for getting this approval takes time. Physicians or their staff typically have to spend the equivalent of two or more days each week negotiating with insurance companies to get approval — time that would be better spent taking care of patients.

    Academy Position

    The Academy believes patients deserve timely access to medically necessary treatment. Too often, prior authorization requirements delay necessary care while adding administrative burdens to physician practices. We believe insurers should not require prior authorization for medically necessary care and should limit such requirements for providers with a strong track of approved procedures.

    What We’re Doing

    Reducing prior authorization burdens is one of the Academy’s top advocacy priorities. The Academy-led multi-specialty Regulatory Relief Coalition is working to secure prior authorization reform in the Medicare Advantage program. We are urging the Centers for Medicare & Medicaid Services to provide oversight of these plans’ prior authorization requirements.

    Our coalition also secured the introduction of the Improving Seniors’ Timely Access to Care Act in the 117th Congress. This bipartisan legislation would reform prior authorization requirements in the Medicare Advantage program in several ways. The act has broad support in Congress and has been endorsed by more than 450 provider, patient and other health care organizations.

    What You Can Do

    At the federal level, use our Academy tool to urge your legislators to support the Improving Seniors’ Timely Access to Care Act. For prior authorization requirements outside Medicare Advantage, you can also notify the Academy when you experience new issues or particularly egregious delays.

    Resources

    American Medical Association Survey on Prior Authorization, 2021

    AMA Report: Physicians Report Prior Authorization Hurts Workforce Productivity