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Health Care Leaders Collaborate to Streamline Prior Authorization and Improve Timely Access to Treatment

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As you are aware, the AMA and 16 other organizations released a set of Prior Authorization and Utilization Management Reform Principles in early 2017, with the goal of spurring conversations with health plans, benefit managers, accreditation organizations, and other health care stakeholders to reduce the administrative burdens and barriers to timely patient care associated with prior authorization programs. We are pleased that many national medical specialty societies and state medical associations signed on as supporters of the principles and are using the document in their advocacy on this important issue.

After the release of the principles, American’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) requested meetings with the AMA to discuss the principles. Follow-up discussions led to the creation of a small workgroup of representatives from the AMA, AHIP, BCBSA,  American Hospital Association (AHA), American Pharmacists Association (APhA), and Medical Group Management Association (MGMA). The goal of this activity was to reach agreement on actions to meaningfully improve prior authorization programs.

The joint AHA/AHIP/AMA/APhA/BCBSA/MGMA press release below announces a consensus statement reflecting the outcome of this small workgroup’s discussions. As detailed in the full consensus statement (accessible via the hyperlink in the release), the participating organizations agreed to encourage reduction in the number of physicians subject to prior authorization through selective application programs; regular review and adjustment of the services and drugs requiring prior authorization; improved transparency and communication regarding prior authorization; protections for continuity of care during health plan or coverage changes; and accelerated adoption of electronic standards for prior authorization and improved transparency of formulary information at the point-of-care. While there are many remaining concerns on this issue that we will continue to work with you to address, we believe that this is an important initial step toward right-sizing prior authorization programs.


If you have any questions about the consensus statement,  please contact Heather McComas (heather.mccomas@ama-assn.org ).

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