AMA adopts new prior authorization reform policies

The American Medical Association House of Delegates approved new prior authorization reform policies during its annual meeting. 

The policies include advocating for increased legal accountability for payers when prior authorization harms patients, according to a June 11 AMA news release shared with Becker's. The AMA will also work to ensure that increased legal accountability is "not precluded by clauses in beneficiary contracts that may require pre-dispute arbitration for prior authorization determinations or place limitations on class action." 

The AMA is also continuing to push for payers to provide prior authorization notifications with detailed explanations regarding the rationale for denials, according to the report. New AMA policy outlines basic information requirements for denial letters that include detailed explanation of denial reasoning, access to policies or rules cited as part of the denial, information needed to approve the treatment and a list of covered alternative treatments. 

The AMA is also continuing its work to support real-time prescription benefit tools that allow physicians access to patient drug coverage information at the point of care in their EHRs, according to the report. The AMA said these tools can streamline access to care and avoid unexpected delays and denials by confirming insurer approved care or providing therapeutically-equivalent alternative treatments that do not require the insurer’s prior authorization.  

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