5 signs of prior authorization reform progress, per the AMA

The American Medical Association's most recent survey found that 89% of physicians say prior authorization had a "significant or somewhat negative clinical impact," but the organization said there are positive signs on the road to reform.

The AMA outlined five positive signs of progress in an April 15 article:

1. CMS finalized a rule in January to streamline the prior authorization process and improve the electronic exchange of health information which it estimates will save $15 billion over 10 years. 

2. Nine states and Washington, D.C., passed prior authorization reform bills in 2023. 

3. Major payers UnitedHealthcare and Cigna announced prior authorization cuts in 2023. 

4. Gold-card legislation, which exempts physicians from prior authorization for certain procedures and treatments if they have a proven record of delivering appropriate care, has passed in Texas and other states. Nationally, a bill was introduced in the House of Representatives in 2023 that would exempt physicians from Medicare Advantage plan prior authorization requirements if 90% of the physicians’ prior authorization requests were approved in the preceding 12 months. 

5. The AMA said patients are speaking up about their experiences with prior authorization, pointing to a March 14 video essay in the New York Times opinion section titled, "What’s My Life Worth?' The Big Business of Denying Medical Care."

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars