Opioid Policies

For Immediate Release

April 5, 2022

Physicians Advocate for Removal of Health Insurance Barriers to Care in District of Columbia

Survey finds prior authorization requirements delay care and harm patients

WASHINGTON – The American Medical Association (AMA) joined the Medical Society of the District of Columbia (MSDC) in supporting a bill to reform the health insurer-imposed approval processes for medical procedures, treatments, and drugs. In a letter delivered today to the Council of the District of Columbia’s Committee on Health, the two physician organizations urged immediate action on the Prior Authorization Reform Act of 2022 as a critically needed measure to rein in bureaucratic insurance requirements that delay and disrupt patient access to necessary medical care in the District of Columbia. 

Survey data released in February by the AMA show that more than nine in 10 physicians (93%) reported care delays while waiting for health insurers to authorize necessary care, and more than four in five physicians (82%) said patients abandon treatment due to authorization struggles with health insurers.

Despite a 2018 commitment from the health insurance industry to streamline prior authorization processes for patients, physicians report that the burden is dramatically increasing, causing a variety of problems for their patients and their practices. In fact, more than one-third (34%) of physicians reported that prior authorization led to a serious adverse event, such as hospitalization, disability, or even death, for a patient in their care.

To help ensure that District patients get the care they need in a timely manner, the Prior Authorization Reform Act of 2022 was introduced by Councilmembers Mary Cheh, Charles Allen, Anita Bonds, Janeese Lewis George, and Vincent Gray. The reform bill would realign what has become a very broken system by introducing new transparency and clinical validity requirements to ensure patients have access to care.

“Prior authorization is one of the biggest impediments to patient care, and this legislation would allow physicians to treat their patients without unnecessary paperwork and delays,” said MSDC President Kirstiaan Nevin, M.D.

“Providing quality care to patients is the top priority of physicians, but waiting for a health plan authorization can delay and disrupt patient-centric care with a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles,” said AMA President Gerald Harmon, M.D. “Almost four years after agreeing with physicians on needed improvements, the health insurance industry has made little progress toward those goals. Failure of health insurers to achieve agreed-upon improvements illustrates a clear opportunity for District councilmembers to rein-in prior authorization requirements that adversely impact patient health.”

In the face of inaction by health insurance companies, it is time for District councilmembers to streamline prior authorization requirements so patients can receive the treatment they need, when they need it. For more information visit: www.fixpriorauth.org.

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Media Contacts:

Robert J. Mills
American Medical Association
Email: robert.mills@ama-assn.org

Pia Duryea
Medical Society of the District of Columbia
Email: duryea@msdc.org