AMA, MGMA support prior authorization reform bill

Keith A. Reynolds

The legislation would require Medicare Advantage plans to have a streamlined electronic authorization process.

The American Medical Association (AMA) and the Medical Group Management Association (MGMA) have both voiced their support for a prior authorization reform bill introduced last week.

The bill would require Medicare Advantage plans to implement streamlined electronic prior authorization process as well as increased transparency and enhanced oversight from the Centers for Medicare & Medicaid Services.

According to a news release, the need for the proposed legislation was highlighted in an AMA-conducted survey from December. The survey found that among the 1,000 practicing physicians who responded 83 percent reported that prior authorizations for prescription medications and medical services had increased over the past five years. While the volume has increased, the lack of transparency has remained with respondents saying it was difficult to determine whether a prescription drugs, 68 percent, or medical services, 58 percent, require prior authorization.

“You would think insurers would ease bureaucratic demands throughout a pandemic to ensure patients’ access to timely, medically necessary care. Sadly, you would be wrong,” Susan R. Bailey, MD, president of the AMA, says in the release. “There is no room in the patient-physician relationship for insurance-industry barriers. The AMA is dedicated to simplifying and right-sizing prior authorization so physicians can properly provide care and patients can receive the timely treatment they deserve. This legislation is a win-win for patients and physicians.”

The MGMA also shared their support for the bill with a statement from Anders Gilberg, senior vice president government affairs, stating the organization’s intent to help the passage of the bill.

“This legislation would simplify administrative processes, remove onerous prior authorization requirements for medical practices, and allow physicians to focus on their primary goal of treating patients,” Gilberg says in the statement. “MGMA is eager to work with Congress to expedite passage of this necessary legislation.”