Health Equity

In 2018, the medical and payer communities announced a voluntary agreement to reform the prior authorization process. Four years later, a new survey shows the payer side is failing to live up to its agreements.

In the survey released Tuesday (see here), over 1,000 physicians were interviewed about the impact of prior authorization on their practice. The results show that some promised reforms are just that - promised. For example:

• 9% (not a typo) of respondents reported "contracting with health plans that offer programs that exempt providers from [prior authorizations]"
• 65% (prescription) and 62% (service) of providers reported it is difficult to determine if their order requires a prior auth request.
• 26% of doctors reported their EHRs enable electronic prior auths for prescriptions
• 88% of doctors still say prior auths interfere with their continuity of care for patients.

“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,” AMA President Gerald Harmon, M.D., said in a statement. “Comprehensive reform is needed now to stem the heavy toll that continues to mount without effective action.”

MSDC is leading an effort in the District to force change in the prior authorization process. Bill B24-655 would align the District with reforms seen in many other states and outlined as best practice by the AMA. MSDC is pushing the Committee on Health to hold a hearing on B24-655 to allow patients and providers to share their stories. If you would like to get involved in MSDC's effort, visit msdc.org/priorauth or contact hay@msdc.org.