Here’s what you should note:
1. The principles pertain to obtaining approval from health plans, benefit managers and other providers that offer care to patients.
2. The 21 principles address five categories including clinical validity, continuity of care, transparency and fairness, timely access and administrative efficiency. The set also features alternatives and exemptions.
3. Through the principles, the coalition aims to highlight the current prior authorization requirements and give realistic ways to bolster the current process and work through its inefficiencies.
4. A recent AMA survey found a medical practice spends an average of 37 prior authorization requirements per physician each week. Of the physicians surveyed, 75 percent described prior authorization burdens as high or extremely high.
“Strict or bureaucratic oversight programs for drug or medical treatments have delayed access to necessary care, wasted limited health care resources and antagonized patients and physicians alike,” said AMA President Andrew W. Gurman, MD, in a statement. “The AMA joins the other coalition organizations in urging health insurers and others to apply the reform principles and streamline requirements, lengthy assessments and inconsistent rules in current prior authorization programs.”
5. Other coalition organizations include American Academy of Child and Adolescent Psychiatry, American Academy of Dermatology, American Academy of Family Physicians, American College of Cardiology, American College of Rheumatology, American Hospital Association, American Pharmacists Association, American Society of Clinical Oncology, Arthritis Foundation, Colorado Medical Society, Medical Society of the State of New York, Minnesota Medical Association, North Carolina Medical Society, Ohio State Medical Society and Washington State Medical Society.
“Health plan demands for prior approval for physician-ordered medical tests, clinical procedures, medications and medical devices ceaselessly question the judgment of physicians, resulting in less time to treat patients and needlessly driving up administrative costs for medical groups,” said Halee Fischer-Wright, MD, MGMA president and CEO. “Most importantly, despite the fact that the vast majority of prior authorization requests are ultimately approved, jumping through these administrative hoops can lead directly to delay or disruption in the delivery of care to the patient. Working together, the coalition has developed a landmark set of principles and I anticipate that this effort will translate directly into a reduction in the waste associated with prior authorization requirements.”
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