Dec 7, 2022 - Health

Medicare Advantage prior authorization rule drops

Illustration: Allie Carl/Axios

Medicare Advantage plans and other government-funded insurers would have to overhaul the electronic process they use to approve medical services and prescriptions under a rule proposed by the Biden administration on Tuesday.

Why it matters: Prior authorization is a top concern of physicians, who say it imposes excessive administrative burdens and have pressed Congress to make changes in the lame-duck session. The rule could dramatically reduce the cost of a Medicare Advantage prior authorization fix.

Yes, but: Insurers say prior authorization is a necessary tool to control costs and make sure care is effective and efficient.

Flashback: CMS initially proposed to improve electronic data exchange among health care payers, providers and patients in the final days of the Trump administration. But the original rule just applied to Medicaid, CHIP and Qualified Health Plans. CMS never finalized the policy.

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