News & Media

MSMS Among Groups Calling for Improvements in Prior Authorization Process

Wednesday, March 13, 2019

The Michigan State Medical Society joined nearly 100 state and national physician advocacy organizations in signing a letter that the American Medical Association sent to the Centers for Medicare & Medicaid Services, urging CMS to “provide guidance to Medicare Advantage (MA) plans on prior authorization (PA) processes through its 2020 Call Letter.” 

The letter states, “CMS’ guidance should direct plans to target PA requirements where they are needed most. Specifically, CMS should require MA plans to selectively apply PA requirements and provide examples of criteria to be used for such programs, including, for example, ordering/prescribing patterns that align with evidence-based guidelines and historically high PA approval rates.”

Additionally, the letter says, “PA programs can create significant treatment barriers by delaying the start or continuation of necessary treatment, which may in turn adversely affect patient health outcomes.”

An AMA survey found that “[medical] practices complete an average of 31 PA requests per physician per week, and this PA workload consumes 14.9 hours – nearly two business days – per week of physician and staff time.”

The letter also emphasizes that physicians “have serious concerns about CMS’ recent notification to MA plans that they will no longer be prohibited from utilizing step therapy protocols for physician administered drugs covered under Medicare Part B this year.” 

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