New Bipartisan Push to Reform Prior Authorization  

By Consumers for Quality Care, on July 10, 2024

A bipartisan bill reintroduced in the U.S. Senate aims to reform prior-authorization processes and standards for consumers on Medicare Advantage plans, according to Axios.   

The Improving Seniors’ Timely Access to Care Act was reintroduced earlier this month. It’s a revised version of an older bill that would have cost $16 billion to implement. The new version requires Medicare Advantage plans to use electronic prior-authorization systems to speed up coverage decisions and cut down on bureaucratic delays. Additionally, health insurers would be required to report their prior-authorization decisions to the Department of Health and Human Services (HHS). Best of all, these reforms can be implemented at no cost to taxpayers.   

In January, the Biden administration implemented new reforms for prior authorization. But if these reforms are not codified into law, they could be reversed, either by a future Presidential administration or by a recently decided Supreme Court case severely limiting federal agencies’ power to interpret regulations.  

Dr. Catheryn Yashar, a radiation oncologist and chief medical officer at UC San Diego Health-La Jolla and Hillcrest Hospitals, described how prior authorization can hurt consumers, saying, “Every doctor can tell you about patients that were delayed, which are frustrating and decrease their options or, even worse, decrease their probability of control and survival.”  

The bipartisan legislation is supported by more than 400 health care organizations representing patients, physicians, hospitals, and other stakeholders. As prior authorization has come under increased scrutiny, support in Congress for the bill has grown, and it is more likely to pass now than it was when it was originally introduced.  

CQC applauds efforts to reform the prior authorization process and urges both lawmakers and providers to eliminate burdensome procedural hurdles that prevent consumers from receiving the medical care they need.