AMA, Academy Urge CMS to Broaden Prior Authorization Reforms

The Academy is partnering with the American Medical Association to call for a comprehensive approach to prior authorization reform at the federal level. In a letter to Centers for Medicare & Medicaid Services head Seema Verma, we take umbrage with the agency’s recent push to address the issue solely through automation. Rather, we believe that a more robust strategy is needed to ensure the cost-savings tool’s judicious use. 

In a letter signed by the AMA, the Academy and dozens of national and state medical groups, we’re urging the following be implemented as a comprehensive strategy for reducing prior authorization’s harms and burdens:

• Selective application of prior authorization to only outliers, based on provider performance on quality measures and adherence to evidence-based medicine
• Review and adjustment of prior authorization lists to remove services and drugs that represent the tool’s low-value use, i.e. those that are overwhelmingly approved
• Transparency of prior authorization requirements to patients and physicians, including the clinical basis for these decisions
• Protections of patient continuity of care
• Automation that can improve the process, thereby making prior authorization more efficient 

In doing so, we reiterate the growing burden levied by prior authorization requests. Recent data shows that it takes practices nearly two business days to process these requests, at a rate of more than 30 each week. Furthermore, more than a quarter of physicians report serious adverse events — ranging from disability to hospitalization and death — stemming from prior authorization delays.