More than 100 lawmakers in Congress are urging Centers for Medicare & Medicaid Services Administrator Seema Verma via letter to reform prior-authorization in Medicare Advantage. The bipartisan letter documents several steps that elected officials want taken to end abuses that are delaying our patients’ necessary care.
This is a big boost to the Academy’s ongoing efforts to spur CMS action on this issue. It also shows the impact that Academy members made during a lengthy grassroots push in August and September, with hundreds of messages sent by our community of U.S. ophthalmologists to enlist representatives in the U.S. House to join this important effort.
The letter was spearheaded by Reps. Phil Roe, MD, R-Tenn., and Ami Bera, MD, D-Calif, at the request of the Academy and the regulatory relief coalition that we’re leading. They urge CMS to make important changes to stem prior-authorization abuses. One suggestion mirrors a key Academy request: that CMS issue guidance to their Medicare Advantage plans, including specific instructions on prior authorization’s use.
Garnering wide support for this letter was among the Academy’s chief advocacy priorities over the summer. We urged you to write to or meet with your elected officials and request they sign this letter. In total, Academy member ophthalmologists sent 284 messages as part of our August recess push.
Our coalition — including cardiology, rheumatology, neurology, urology and neurosurgery —strengthened our request with nearly 100 follow-up meetings with congressional staff.
Multiple state ophthalmology societies amplified this effort by contacting their congressional delegations. We also partnered to educate lawmakers on the issue during the Academy’s Congressional Advocacy Day in April.
Medicare Advantage plans employ prior authorization as a cost-control mechanism, but instead this results in delaying medically necessary care. In every meeting with CMS during the last year, we’ve reiterated that the proliferation of prior-authorization requirements is increasingly damaging to our patients’ care.
Prior-authorization abuse in Medicare Advantage hits our profession especially hard. Retina specialists and patients are particularly burdened by these administrative requirements, which sometimes delay medically necessary care.
For example, some plans now require prior authorization for each visit for age-related macular degeneration. Most of the time, these requests are approved, but only after delaying treatment. We strongly oppose any policy that could unnecessarily delay care that patients need.
Congress’ outpouring of support is October’s second major development on this issue. Just last week, we told you how the U.S. Department of Health and Human Services’ Office of the Inspector General concluded that Medicare Advantage plans are implementing profit-driven policies that are delaying medically necessary care and treatments.