• House Small Business Committee Members Join Academy’s Fight to Get Medicare Advantage Plans to Halt Prior Authorization


    The Academy keeps pushing in response to CMS direction to Medicare Advantage plans that urged them to exercise “flexibility” in using prior authorization requirements for the duration of COVID-19 emergency. This week our efforts won support from several members of the House Committee on Small Business.

    The Centers for Medicare & Medicaid Services took a step in the right direction April 21 by issuing new guidance to Medicare Advantage plans to exercise “flexibility” in using prior authorization to make sure patients do not experience delays in getting care or prescriptions during the COVID-19 public health emergency.

    But the Academy does not feel the guidance goes far enough in protecting patient safety. In fact, plans appear to be tone deaf; United Healthcare just released its increased list of prior authorization requirements, and other plans have substantially delayed prior authorization approvals. In addition, documented reports from individual physicians and pharmaceutical companies that many plans are not responding to or delaying prior authorization has heightened our concerns about medical risks.

    On May 4, five Democratic members of the House Committee on Small Business fortified the Academy’s efforts in urging that CMS instruct Medicare Advantage and Part D prescription drug plans waive prior authorization requirements for the duration of COVID-19 emergency.

    Committee members, including committee Chair Rep. Nydia Velazquez, D-N.Y., strongly urged CMS Administrator Seema Verma to take action to help patients who’ve already been hurt by the COVID-19 pandemic. “Patients who still require treatment should not be burdened with the delays caused by prior authorization requirements,” the committee said in a letter to the agency.

    “It is not in the interest of the public to require medical professionals to devote their precious time to billing when they should be worrying about patients,” the lawmakers told the agency.

    The Academy is pleased CMS recognized the urgency of reducing burdens through rules during the pandemic. CMS specifically encouraged plans to consider waiving or relaxing “prior authorization requirements at any time in order to facilitate access to services with less burden on beneficiaries, plans and providers.”

    The Academy, through our Regulatory Relief Coalition, has been trying to put CMS’ stated goal — to ensure patient safety through timely access to care — into policy. Our efforts to remove these burdensome obstacles and delays to care include:

    • In March, in a letter to CMS Administrator Seema Verma, the Academy-led coalition urged the agency to lift Medicare Advantage plan prior authorization and step therapy requirements during the COVID-19 public health emergency.
    • In April, the coalition pressed governors and insurance commissioners from all 50 states to waive all prior authorization requirements during the pandemic.
    • We’ve been working with champions in Congress to pass the bipartisan Improving Seniors’ Timely Access to Care Act (HR 3107) since it was introduced last year. It would rein in Medicare Advantage plans’ use of prior authorization. We are pushing for the legislation to be including in a new COVID-19 relief bill when lawmakers return to Washington, D.C., this month.
    • Finally, easing the burdens of prior authorization and step therapy will be the focus of our efforts in meetings with lawmakers and congressional staff during the Academy’s first-ever Virtual Hill Day on May 12.