Hello patient advocates!
Dr. Angus Worthing, chair of the American College of Rheumatology’s Government Affairs Committee, here to give you an important update on prior authorization and how lawmakers are working to protect patient access to treatment.
As you may know, prior authorization is a protocol that many insurers use, which requires that your doctor gain approval from your insurance plan before the plan will pay for certain prescriptions. While insurers often argue that this process ensures patient safety and cuts costs, these arguments don’t hold up to reality.
Surveys show that prior authorization is a significant contributor to treatment delays, and 92% of providers said prior authorization has a negative effect on patient clinical outcomes, according to research conducted by the American Medical Association. These delays are especially severe for patients enrolled in Medicare Advantage plans, where strict prior authorization requirements needlessly delay or outright deny medically necessary care.
To make matters worse, these heavy-handed prior authorization protocols also worsen care outcomes since treatment isn’t delivered in a timely fashion.
Fortunately, the U.S. House of Representatives recently introduced legislation that would ensure patients enrolled in Medicare Advantage plans are protected from prior authorization requirements that unnecessarily delay care. The Improving Seniors’ Timely Access to Care Act (H.R. 3107) would improve patient access by requiring the Centers for Medicare and Medicaid Services (CMS) to regulate the use of prior authorization by Medicare Advantage plans. The legislation would also better streamline the delivery of care by establishing a process to make ‘real-time decisions’ for services that are regularly approved.
Importantly, the legislation would increase transparency around the use of prior authorization by requiring plans to report to CMS how extensively they use prior authorization and how often they approve or deny relevant medications and other treatments.
We need your help in getting this much-needed legislative fix. Ask your representative to support H.R. 3107, The Improving Seniors’ Timely Access to Care Act, so patients have access to the medically necessary treatment they need and deserve.
Dr. Angus Worthing