How Physicians are Healing the Prior Authorization Process

How Physicians are Healing the Prior Authorization Process

- February 25, 2018

It’s no secret that physicians and patients have become frustrated with the recently enacted prior authorization policies.

Jack Resneck Jr., M.D. said he used to fill out prior authorization requests only when he was prescribed a new or unusually expensive medication or diagnostic tests for patients. However, this has drastically changed.

Dr. Resneck stated, “Sometimes, health plans deny reasonable prior-authorization requests for evidence-based treatments and instead send back ‘suggested alternatives’ that are completely inappropriate for the disease being treated.  We also now have to submit prior-auth requests for many patients who are already stable on a therapy when their health plan suddenly changes the rules.”

Many physicians and organizations have joined with the AMA to reform prior authorization and help physicians and patients. In January of 2017, the AMA and 16 other health care and patient associations issued 21 principles for reforming prior authorization and utilization-management requirements. The AMA, America’s Health Insurance Plans (AHIP), and other collaborators have released a consensus statement declaring their devotion to changing the prior authorization process.

This statement stresses the importance of communication and collaboration between those who signed the statement and listed 5 opportunities to improve the prior authorization process and details agreements to take specific action on each of these to produce the desired reform.

The 5 opportunities are:

  1. Selective Application for Prior Authorization
  2. Prior Authorization Program Review and Volume Adjustment
  3. Improved Transparency and Communication Regarding Prior Authorization
  4. Protections or Continuity of Patient Care
  5. Automation to Improve transparency and Efficiency of Prior Authorization Requirements and Processes.

A survey conducted by the AMA found that the average physician takes 37 prior authorization requests a week and spends 16.4 hours doing this. This causes serious delays in patient care, but with the reforms the AMA hopes to implement physicians can provide fast quality patient again.


Written by Oracle RX Team

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