A new bill, the Improving Seniors’ Timely Access to Care Act, aims to streamline the prior authorization process.
“The prior authorization process has become unmanageable for both doctors and patients. Insurer red tape imposes a significant burden on clinicians, leading to unnecessary and unclear delays, or even outright denials of patient care,” says ACR President Deborah Dyett Desir, MD.1
Payers use prior authorization to limit or control access to specific medical treatments and services, often defaulting to denial of treatments that are ultimately approved in over 95% of cases. Because the requirements for prior authorization are not uniform, the process frequently involves hours of paperwork and administrative strain for physicians and healthcare professionals, often preventing patients from promptly accessing their best treatment options.
“This bill enhances transparency and urges insurers to adopt evidence-based medical guidelines in their prior authorization decisions,” says Dr. Desir.
The new bill includes changes to reflect policies implemented by the Centers for Medicare & Medicaid Services since the last attempt at passage. It is based on legislation that unanimously passed in the U.S. House of Representatives and garnered more than 50 Senate co-sponsors in the prior Congress.
“The ACR stands united with hundreds of physicians, patients, hospitals and other key stakeholders in endorsing this bill,” says Dr. Desir. “We strongly urge Congress to act swiftly and pass this bill.”
Reference
- American College of Rheumatology applauds re-introduction of legislation to reform prior authorization policies [news release]. American
College of Rheumatology. 2024 Jun 12. https://rheumatology.org/press-releases/american-college-of-rheumatology-applauds-prior-authorization-
rule.
