Major medical organizations call for prior authorization reforms
The group claims that requiring the prior authorization of insurance companies before patients can access certain drugs or treatments complicates medical decisions and delays or completely interrupts medical services. The coalition asserted that prior authorization programs place cost savings ahead of optimal care.
The coalition has released a set of principles grouped into the five categories of clinical validity; continuity of care; transparency and fairness; timely access and administrative efficiency; and alternatives and exemptions.
“This group strongly urges health plans, benefit managers and any other party conducting utilization management (“utilization review entities”), as well as accreditation organizations, to apply the following principles to utilization management programs for both medical and pharmacy benefits,” reads the introduction to the list of guiding principles. “We believe adherence to these principles will ensure that patients have timely access to treatment and reduce administrative costs to the health care system.”
According to coalition member American Medical Association (AMA), “the undue burdens of preauthorizing medical care have reached a critical level.” In a recent survey conducted by the AMA, almost 90 percent of doctors said prior authorization requirements sometimes, often or always delay access to care for their patients.
The AMA is joined in the coalition by the American Academy of Child and Adolescent Psychiatry, American Academy of Dermatology, American Academy of Family Physicians, American College of Cardiology, American College of Rheumatology, American Hospital Association, American Pharmacists Association, American Society of Clinical Oncology, Arthritis Foundation, Colorado Medical Society, Medical Group Management Association, Medical Society of the State of New York, Minnesota Medical Association, North Carolina Medical Society, Ohio State Medical Association and Washington State Medical Association.
Organizations in this story
American Academy of Family Physicians 11400 Tomahawk Creek Pkwy Leawood, KS - 66211