American Medical Association (AMA): New Prior Authorization Regulation To Benefit Patients And Physicians

“The American Medical Association (AMA) applauds Centers for Medicare & Medicaid Services (CMS) Administrator Brooks-LaSure for heeding patients and the physician community in a final rule that makes important reforms in government-regulated health plans’ prior authorization programs for medical services.

“Today’s final rule requires impacted plans to support an electronic prior authorization process that is embedded within physicians’ electronic health records, bringing much-needed automation and efficiency to the current time-consuming, manual workflow. The AMA also appreciates that the rule will significantly enhance transparency around prior authorization by requiring specific denial reasons and public reporting of program metrics as well as requiring that prior authorization information be available to patients to help them become more informed decision makers.

“The AMA commends the Biden Administration for its prior authorization reforms that prioritize patients’ access to care and reducing administrative burdens for physicians and their staff. The AMA looks forward to continuing to work with CMS on this critical issue, including expanding these improvements to drug prior authorization. Through our Recovery Plan for America’s Physicians, the AMA is working on every front to tackle prior authorization challenges so physicians can focus on patients rather than insurance obstacles to medically necessary care.”