Sticky Ideas

Good ideas have a sticky quality; they hang around until they’re put into action. Bipartisan legislation that was recently reintroduced in the U.S. House of Representatives proves this. The Improving Seniors’ Timely Access to Care Act, H.R. 3173, again seeks to reform prior authorization processes of Medicare Advantage (MA) plans and require “real time” decisions in certain cases. The bill snagged 95 cosponsors within the first week of its introduction.

The case for streamlining and standardizing prior authorization is clear. An audit by the U.S. Department of Health & Human Services’ (HHS) Office of the Inspector General revealed that MA plans ultimately approved 75% of requests that were originally denied. The consequences of a plan initially saying ‘no’ to coverage, then ultimately approving it weeks later, are risky delays to diagnosis and treatment, compounded administrative burdens and time lost that otherwise would’ve been used for direct patient care. Patients, especially those with complex chronic conditions, their caregivers and medical team know first-hand the disruption caused by prior authorization.

Patients + Providers United applauds the sponsors of H.R. 3173 because prior authorization policies should never enable bureaucratic middlemen to interfere with the carefully crafted, individualized treatment plans physicians develop for their patients.