• Academy Highlights Medicaid Actions to Press for Broader Prior Authorization Relief


    As the Academy-led Regulatory Relief Coalition moves to focus efforts on suspending prior authorization requirements at the state level, we are highlighting the progress made for Medicaid patients during the COVID-19 crisis.

    Some 47 states have issued some form of prior authorization waiver for Medicaid services during COVID-19, according to an American Medical Association analysis. Of these, 43 states have fully waived prior authorization requirements for Medicaid fee-for-service patients during COVID-19. The 13-society coalition is calling on all states to waive prior authorization for all patients, not just Medicaid.

    The move is one in a series of steps the Academy has initiated to remove prior authorization requirements as the pandemic limited ophthalmology and other physician practices’ available. staff. These burdens delay medically necessary care to patients who have been waiting for treatment.

    In April, the coalition began pressing governors and insurance commissioners from all 50 states to waive all prior authorization requirements during the pandemic, and in May, the Academy-led coalition released an open letter urging health plans them to waive prior authorization and similar utilization review requirements for all patients during the crisis. The letter highlighted that Medicaid plans have already eliminated many prior authorization requirements and urged health plans to follow suit.

    The Academy has developed a media tool kit to assist state societies to engage in this campaign. Building media relationships, engaging state officials, and establishing your state society as one of the leading voices for reform in your state will be key to success for our patients’ access. Our other efforts include:

    • At the federal level, we're working with champions in Congress to pass the bipartisan Improving Seniors' Timely Access to Care Act, which was introduced last year. This bipartisan bill aims to increase transparency, reduce prior authorization burdens and streamline the prior authorization approval process in the Medicare Advantage program.
    • Easing the burdens of prior authorization and step therapy was a focus of our efforts in meetings with lawmakers and congressional staff during Virtual Advocacy Day on May 12.