On Monday, the Blue Cross Blue Shield Association, AHIP, and 48 insurance carriers announced a new plan to address issues related to prior authorization. Over the next two years, these insurers intend to reduce the number of prior authorization requests, improve standardization and response times, and work more closely with healthcare providers on the process.
This is not the first time insurers have promised changes. In 2018, payers signed a consensus statement with organizations such as the American Medical Association (AMA), the American Hospital Association, and others representing medical professionals and pharmacists. At that time, insurers made commitments aimed at making prior authorization less burdensome.
Despite those promises, AMA survey data has shown that physicians still see prior authorization as a significant obstacle to patient care. By 2022, the AMA stated that “Insurance companies are not following through with agreed upon prior authorization reform,” citing continued negative feedback from physicians. Current surveys indicate that problems persist for doctors dealing with prior authorization requirements.
U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz have expressed optimism about this latest effort. Dr. Oz told Modern Healthcare, “There’s violence in the streets over these issues” and “Americans are upset about it.” He said he believes this initiative could be different because more insurers are involved now, public dissatisfaction is high, and there is a commitment to improving interoperability.
The Florida Medical Association (FMA) has stated it will monitor whether this new commitment prevents carriers from being subject to legislative or regulatory measures like time limits for responses or bans on retroactive denials. The FMA noted that while some may argue insurers would resist further regulation by claiming they are already addressing concerns voluntarily, history suggests skepticism may be warranted regarding self-regulation by insurers.
