370 Healthcare Groups Send Letter to Congress Urging Prior Authorization Reform in Medicare Advantage

WASHINGTON, DC, Sept. 11, 2019 – The American College of Rheumatology (ACR), along with 369 other leading patient, physician, and healthcare professional organizations, sent a letter to Congress urging passage of the Improving Seniors’ Timely Access to Care Act of 2019 (H.R. 3107), a bipartisan bill to protect Medicare Advantage beneficiaries from prior authorization requirements that needlessly delay or deny access to medically necessary care.

Introduced by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA), the Improving Seniors’ Timely Access to Care Act would make it easier for patients to access medically necessary treatments by requiring the Centers for Medicare & Medicaid Services (CMS) to regulate the use of prior authorization by Medicare Advantage plans. The bill would also increase transparency by mandating that health insurance plans report to CMS their prior authorization usage rate and the frequency with which they approve or deny coverage.

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“While intended to control costs, the unregulated use of prior authorization has devolved into a time-consuming and obstructive process that often stalls or outright revokes patient access to medically necessary therapies,” said Paula Marchetta, MD, MBA, president of the ACR. “Many healthcare plans now use prior authorization indiscriminately, ensnaring the treatment delivery process in webs of red tape and creating gratuitous hurdles for patients and providers. Patients, physician groups, hospital associations and other key stakeholders all agree that reform is needed.”

According to a study conducted by the American Medical Association, over a quarter of doctors surveyed said prior authorization has led to a “serious adverse event” for patients, such as hospitalization and permanent bodily damage. The same study found that 91 percent of doctors say that prior authorization is associated with treatment delays.

As part of the Regulatory Relief Coalition – a group of national physician specialty organizations – the ACR has been a staunch advocate for reducing regulatory burdens in the Medicare program to assure patients have access to timely and medically necessary treatment.

The full letter is available here.