• Nation’s Medical Specialists Demand Immediate End to Prior Authorization Abuse

    WASHINGTON — October 18, 2018 — A coalition comprised of the nation’s major medical specialties is demanding that the Trump administration take immediate action to ensure patients’ timely access to care. They are taking this action because patients are suffering from delays in care that are caused by the misuse of prior authorization requirements by Medicare Advantage plans. 

    The members of the Regulatory Relief Coalition are seeking to halt these abuses, the profound effect of which is evident in patients who receive regular injections to preserve vision as well as those who receive infusion treatments for crippling conditions.

    Prior authorization is a tool that insurers use to reduce health care spending but often delays medically necessary treatments by forcing patients to obtain permission first. 

    Recent surveys by the American Medical Association and American College of Surgeons show how some insurance plans overuse this tool. One survey showed that on average, a medical practice will complete nearly 30 prior authorization requests for each physician every week. Each prior authorization takes about 15 hours to process. Following delays, requests are approved 90 to 100 percent of the time. 

    As a result, it is increasingly a prominent barrier to access that interferes with the physician-patient relationship. 

    “President Trump, it’s time to reign in insurance companies whose misuse of prior authorization is threatening patients’ outcomes,” said Cathy G. Cohen, vice president for government affairs for the American Academy of Ophthalmology. “It won’t take much — just instruct Medicare Advantage plans on when and how prior authorization is to be used.” 

    The coalition has championed this issue for more than a year. Its members have met with the Centers for Medicare & Medicaid Services leaders, the insurance industry, patient organizations, and Congress during that time. As a result, prominent patient advocacy groups — including the Medicare Rights Center — and Congress have joined this effort. 


    About the Regulatory Relief Coalition

    The Regulatory Relief Coalition is a group of 10 national physician specialty organizations advocating for a reduction in Medicare program regulatory burdens so that physicians can spend more time with patients.  

    American Academy of Dermatology Association * American Academy of Neurology * American Academy of Ophthalmology * American Association of Neurological Surgeons * American College of Cardiology * American College of Rheumatology * American College of Surgeons * American Society of Clinical Oncology * American Urological Association * Congress of Neurological Surgeons