Survey shows lack of progress on prior authorization reforms

Prior authorization reforms are not being implemented as planned, according to survey results released by the American Medical Association.

In December 2021, the AMA conducted a survey of more than 1,000 practicing physicians about each of the five prior authorization reforms outlined in a 2018 AMA consensus statement.

According to the results of the survey, less than 1 out of 10 physicians (9%) contract with health plans that offer programs that selectively apply prior authorization requirements. The vast majority of responding physicians (84%) indicate that both the number of drugs and medical services requiring prior authorization has increased since the release of the consensus statement. More than 6 in 10 participants report that it is difficult to determine whether a drug (65%) or medical services (62%) requires prior authorization. Nearly 9 in 10 physicians report that prior authorization interferes with continuity of care, while only one-quarter say that their electronic health record system offers electronic prior authorization for prescription medications.

"Waiting on a health plan to authorize necessary medical treatment is too often a hazard to patient health," Gerald E. Harmon, M.D., president of the AMA, said in a statement. "Authorization controls that do not prioritize patient access to timely, optimal care can lead to serious adverse consequences for waiting patients, such as a hospitalization, disability, or death. Comprehensive reform is needed now to stem the heavy toll that continues to mount without effective action."

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