Recent prior authorization reforms by CMS are a significant step in the right direction but are not an all-encompassing solution, according to the American Medical Association.
"[The reforms] are going to go a long way to reducing the burdens on physicians, and most importantly, reducing delays in care for our patients," AMA President Jesse Ehrenfeld, MD, said in an episode of "AMA Update" posted Jan. 25.
There were three main recent updates made to prior authorization policies. Plans are now required to support electronic prior authorization processes by 2027, include the reasoning behind any prior authorization denials, and require all decisions to be made within 72 hours for urgent requests or seven days for standard requests. Dr. Ehrenfeld expects these changes to be game changers.
"These reforms are expected to save physician practices $15 billion over the next decade, a figure that is just hard to even fathom," Dr. Ehrenfeld said. "And it's not possible to put a price tag on the relief that physicians and patients are going to get from these."
Although the changes apply only to government health plans, Dr. Ehrenfeld said he hopes commercial and employer plans follow suit.
Beyond national policy changes, states have begun to take prior authorization reform into their own hands. According to the AMA, 17 states have adopted comprehensive policy updates, and there are more than 70 bills of various types in more than 28 states being introduced this year.
Private insurers such as Cigna and UnitedHealthcare have also moved to reduce prior authorization-related burdens on physicians and patients in the last year.
"The bottom line is that insurers know the pressure is on," Dr. Ehrenfeld said. "Policymakers know the pressure is on. And the progress, it's not as fast as we want, but it's happening."