Valued Voice

On June 23, top federal health officials announced an agreement by a group of private health insurers to voluntarily make improvements to their prior authorization processes.

Under the voluntary agreement announced this week by Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz, participating health insurers pledged to standardize and streamline prior authorizations in their Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace and commercial plans.

According to HHS, the health insurers committed to standardizing electronic prior authorization submissions, including by expanding real-time approvals to 80% of prior authorizations and reducing the number of services requiring prior authorization, by 2027.

The announcement comes about a month after re-introduction of a WHA-backed bipartisan bill in Congress meant to curb prior authorization abuse in Medicare Advantage. The Improving Seniors Timely Access to Care Act seeks to provide federal statutory protections against prior authorization abuse. While the voluntary announcement is a welcomed development, the federal legislation would require specific transparency measures of health insurers relating to their use of prior authorization, as well as enforcement mechanisms to hold them accountable.

WHA will continue to support this important federal legislation and is exploring other efforts to reduce the burden of prior authorization on health care providers and the patients they serve.