- Home
- Advocacy
- Latest News and Practice Data
- The AMA, CAP and Others Support Proposed Prior Authorization Reforms
The American Medical Association (AMA), the CAP, and over 110 other medical societies supported meaningful prior authorization reforms proposed for Medicare Advantage and the Medicare prescription drug benefit. The group has asked the Centers for Medicare & Medicaid Services (CMS) to finalize proposed prior authorization reforms that target the inappropriate use of authorization requirements by Medicare Advantage plans to delay, deny, and disrupt the provision of medically necessary care to patients.
On February 13, they sent a letter to the CMS encouraging them to finalize as it represents significant advancements in reforming prior authorization policies. The group stated that the proposed reforms must be implemented amid mounting evidence that Medicare Advantage plans delay or even prevent Medicare beneficiaries from getting optimal care. The proposals could be better, but they are major steps forward in the collective prior authorization reform efforts.
In late December 2022, the CMS issued a Medicare Part C and D Proposed Rule. The proposed prior authorization reforms reflect many of the AMA policies for which the AMA, the CAP, and others have been advocating in the states and at the federal level for many years, including:
- increased clinical validity of coverage criteria;
- restrictions on retroactive denials after prior authorization approvals;
- a grace period for patients switching plans to promote continuity of care;
- greater physician-patient autonomy in determining where care can be provided and by whom; and
- prior authorization information at the point-of-care.