More oversite of authorization controls is needed

Statement attributed to:
Gerald E. Harmon, M.D.
President, American Medical Association

April 28, 2022

“An investigation by the inspector general’s office of the Health and Human Services Department into the inappropriate use of prior authorization by Medicare Advantage plans uncovered information that mirrors physician experiences. Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied, or disrupted.  The American Medical Association agrees with the federal investigators’ recommendations for preventing inappropriate use of authorization controls to delay, deny and disrupt patient care, but more needs to be done to reform prior authorization. To rein in excessive and unnecessary prior authorization requirements and improve care delivery for America’s seniors, the AMA supports The Improving Seniors’ Timely Access to Care Act (HR 3173 / S 3018), which would require Medicare Advantage plans to streamline and standardize prior authorization processes and improve the transparency of requirements. The proposed federal legislation has gained bipartisan support from more than 300 members in both chambers of Congress. The time is now for federal lawmakers to act to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality health care they need.”