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Health Insurer’s Failure to Remove Barriers to Care and Streamline Prior Authorization Requires Legislative Action Addressing Burdens

Health Insurer’s Failure to Remove Barriers to Care and Streamline Prior Authorization Requires Legislative Action Addressing Burdens

New survey finds potentially harmful consequences of prior authorization process imposed by health insurers on necessary care

Tuesday, August 11, 2020
Earlier this year, hundreds of Michigan patients, their advocates, and their physicians packed multiple legislative committee hearings to share their experiences with insurance company prior authorization regulations. New survey data released by the American Medical Association (AMA) bolsters what they testified to lawmakers -burdensome prior authorization red tape is adversely affecting patient outcomes.

According to the survey, 91% of physicians say prior authorization leads to delays in care and 16% report the delay in care has led to a patient’s hospitalization. Despite
a commitment by insurers two years ago to streamline prior authorization for patients, America’s physicians and their staff report in this poll that they still spend an average of two business days each week completing prior authorization forms and requirements and 86% of those surveyed say that the burden is increasing.

Prior authorization has long prevented patients from receiving the care they need from their physicians — causing treatment delays of days and weeks, or sometimes even months. In fact, 24% of the AMA’s survey respondents reported that a prior authorization has led to an adverse event for one of their patients. Moreover, today, as the nation faces the COVID-19 pandemic, prior authorization continues to interfere with access to care by forcing patients to make multiple trips to the pharmacy, delaying transfers out of hospital settings, and pulling valuable practice resources away from patient care when they need it most.

“Our patients are suffering because insurers, even during a pandemic, are choosing profits over patient care. This must stop,” said AMA President Susan R. Bailey, M.D. “Because insurers will not change their ways despite their rhetoric, policymakers have an important opportunity to rein in prior authorization requirements that adversely affect patient health.”

The AMA and Michigan State Medical Society (MSMS) are urging federal lawmakers to pass
H.R. 3107. The bipartisan legislation would improve care delivery for America’s seniors by requiring Medicare Advantage plans abide by many of the concepts outlined in the consensus statement, such as streamlining and standardizing prior authorization and improving transparency of health insurer programs. A bipartisan group of 234 members of the U.S. House of Representatives have co-sponsored the bill, including five members of Michigan’s congressional delegation. The AMA and MSMS appreciate the support of U.S. Representatives Jack Bergman, Daniel T. Kildee, Haley Stevens, Fred Upton and Tim Walberg.

Meanwhile, MSMS, as part of the
Health Can’t Wait Coalition, has been working on the state-level to streamline prior authorization and protect patients from unnecessary barriers to care. Most recently MSMS supported S.B. 612, which would introduce new transparency and clinical validity requirements to ensure patients have access to care.

“MSMS and the AMA call on Michigan lawmakers to take action in the coming legislative session on behalf of patients and enact S.B. 612. Now is the time to make sure that insurers are not standing in the way of patients’ access to covered services, deterring patients from seeking care, or intruding the patient-physicians relationship.” stated Bobby Mukkamala, M.D, MSMS president and chair-elect of the AMA Board of Trustees.

To learn more about the Health Can’t Wait coalition and to join the fight to rein in harmful prior authorization programs, visit
healthcantwait.org.