Imagine a patient with a serious health condition waiting for weeks to receive treatment approval while their health declines. This scenario is all too common due to prior authorization requirements, which have been around for decades as a cost containment method for health plans. While the goal of prior authorization is to manage costs and ensure that patients receive necessary care, it can be a significant administrative burden for physicians.  

A December 2023 survey conducted by the American Medical Association (AMA) found that prior authorization is, “wreaking havoc on patient outcomes, physician burnout, and productivity.” In the survey of 1,000 physicians, 27 percent reported that their prior authorization requests are often or always denied. Additionally, 95 percent of physicians indicated that prior authorization adds to the burnout they are already experiencing. These requirements can lead to delays in care, which, according to 87 percent of the physicians surveyed, ultimately result in higher overall utilization.  

Last week, the United States House of Representatives and the Senate reintroduced bills H.R. 8702 and S. 4518, respectively, aiming to modify prior authorization requirements, specifically for seniors in the Medicare Advantage (MA) program. These bipartisan bills propose creating an electronic prior authorization process for MA plans, improving transparency around the requirements, increasing beneficiary protections, and mandating agencies to report various metrics to Congress to analyze effectiveness.  

The bills, titled Improving Seniors’ Timely Access to Care Act, unanimously passed the House during the previous session of Congress and garnered considerable cosponsors in both chambers. This legislation aims to enhance patient access to care and reduce the administrative burden on physicians. 

Prior authorization reform is crucial for improving access to healthcare. Streamlining the process and enhancing transparency will lead to better patient outcomes and reduced physician burnout.