The bill, which passed the House in September, would establish an electronic prior authorization process and require Medicare Advantage plans to report to CMS the extent of their use of prior authorization and the rate of approvals or denials. It would also require HHS to develop a process for “real-time decisions” on items and services that are routinely approved.
A companion bill has been introduced in the Senate and currently has 51 co-sponsors, the AMA said in the post. The organization is working to increase that total to 60 or higher. One challenge to garnering support, however, is a Congressional Budget Office report that estimates the bill will likely result in $16 billion in increased spending over 10 years because physicians will have more time to spend with patients after reforms are enacted.
AMA President Jack Resneck Jr., MD, called the report “totally maddening.”
“Patients who are not getting care because of prior auth will actually get the care they need and that’s a negative — totally frustrating,” he said in the post.
Dr. Resneck said AMA’s data shows that the average physician across all specialties now does 41 prior authorizations a week.
“This burden has really spiraled out of control and enough is enough,” he said.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
