As Congress and the Trump administration make moves to improve prior authorization, the head of the biggest doctor group in the country is warning that automating the process isn’t enough.
The American Medical Association (AMA) kicked off its annual advocacy conference in Washington, D.C., Tuesday with speeches from several lawmakers and high-ranking administration officials on their desire to take on prior authorization, a time-intensive and controversial burden on providers. But the head of the AMA is warning a swifter process for approving prior authorization requests isn’t the end-all, be-all solution.
Centers for Medicare & Medicaid Services Administrator Seema Verma told the doctors the agency is ready to “take action” on prior authorization.
“Prior authorization requirements are a primary driver of physician burnout,” said Verma, who also said the current prior authorization process is “indefensible.”
“While prior authorization is an important utilization management tool, we believe we can use automation to make the process more efficient,” Verma added.
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Prior authorization is often cited as the most costly and time-consuming activity for providers
But while the AMA enthusiastically supports automating the process, President Patrice Harris, M.D., cautioned that electronic prior authorization isn’t a comprehensive solution to the problem.
“One of the worries that we have is that everyone thinks that is a panacea, that if we can make these electronic that will solve all the problems,” Harris told FierceHealthcare during the conference.
Harris said prior authorization was created by insurers to ensure the newest treatment alternative, which is often the priciest, was used appropriately.
“It was really meant for those high-dollar, very expensive treatments,” she said.
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But there have been several examples of prior authorization being employed for low-cost drugs such as generics, Harris added.
Verma didn’t say what specific actions the administration aims to take on the issue. The agency last year published a proposed rule to update the Part D e-prescribing program to expedite prior authorizations.
The proposed rule would implement the new prior authorization transaction standards for Part D plans starting in January 2021.
Congress is also exploring action on prior authorization. Rep. Suzan DelBene, D-Washington, told attendees of the wide bipartisan support and 173 co-sponsors for her bill that sets up guardrails for prior authorization.
The legislation would standardize prior authorization across Medicare Advantage plans. It also would exempt surgical services from prior authorization if a surgeon must perform additional services while a patient is in surgery.
“I know that just because you have a piece of legislation doesn’t guarantee it will happen,” said DelBene, who added that she is trying to secure a markup of the legislation in the House Ways and Means Committee.
“I feel good about this bill, because we have strong bipartisan support,” she said.