Health plans pledge to simplify pre-treatment reviews
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More than 50 health insurers are committing Monday to simplifying pre-treatment reviews and address a practice widely despised by health care providers and patients.
Why it matters: Insurers maintain that requiring a sign-off before patients care get care is necessary to control costs and make sure treatments and medications are safe and effective.
- But more than 8 in 10 physicians said that issues with prior authorization requirements led patients to abandon treatment, according to an American Medical Association survey last year. Nearly 90% said prior authorizations contribute to burnout.
State of play: Leading health plans today will voluntarily commit to answer at least 80% of electronic prior authorization requests that have the necessary clinical documentation in real time by 2027.
- The insurers also said they'll work to create common electronic prior authorization submission requirements for plans and providers by Jan. 1, 2027.
- The commitments cover all insurance markets, including private health plans and Medicare Advantage.
AHIP and the Blue Cross Blue Shield Association led the commitments. UnitedHealthcare, Aetna CVS Health, Cigna, Elevance and Kaiser Permanente are among the other companies on the pledge.
- Each is committing to reduce the claims subject to prior authorization "as appropriate for the local market" by the start of next year, according to a joint news release.
- The insurers will also honor prior pre-treatment approvals when patients change plans during the course of treatment over a 90-day transition period.
What they're saying: Physicians offered measured approval of the initiative.
- "While this commitment is a step in the right direction, we will ultimately measure its impact by real changes in the day-to-day experiences of patients and the physicians who care for them," Shawn Martin, CEO of the American Academy of Family Physicians, said in a statement included in insurers' news release.
Flash back: Major trade associations for health insurers, physicians, hospitals and pharmacists released a consensus statement in 2018 on improving prior authorization, but patient and provider concerns have persisted.
- Congress last year considered — but ultimately did not pass — legislation that would have overhauled prior authorization in Medicare Advantage. And the Biden administration issued rules to make insurers streamline requests to cover treatments.
- Several insurers have announced their own plans to scale back their prior authorization requirements over the past couple of years.
