New final rule includes provisions toward right-sizing the prior authorization process imposed by Medicare Advantage plans
Statement attributed to:
Jack Resneck Jr., M.D.
President, American Medical Association
April 6, 2023
“As the American Medical Association (AMA) continues to analyze the details of a new final rule that revises Medicare Advantage and the Medicare prescription drug benefit, an initial read suggests that the Centers for Medicare & Medicaid Services (CMS) has taken important steps toward right-sizing the prior authorization process imposed by Medicare Advantage plans on medical services and procedures. The AMA applauds CMS Administrator Brooks-LaSure for leading the effort to include provisions in this final rule that will ensure greater continuity of care, improve the clinical validity of coverage criteria, increase transparency of health plans’ prior authorization processes, and reduce care disruptions due to prior authorization requirements. The AMA has long advocated for such meaningful prior authorization reforms and Medicare Advantage enrollees will benefit from the important new protections. The AMA looks forward to working with CMS to bring a similar level of reform to Medicare’s drug benefit program. Through our Recovery Plan for America’s Physicians the AMA is working on every front to right-size prior authorization programs so that physicians can focus on patients rather than insurance obstacles to medically necessary care.”
