New ACP Toolkit Empowers Members to Lobby for Prior Authorization Reform

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Members can use the toolkit to learn about the policy landscape and take action to help advocate for reform at the state and federal levels

Oct. 20, 2023 (ACP) -- Current prior authorization procedures can cause unnecessary delays in patient care and administrative roadblocks for physicians. Reducing these burdens has long been an advocacy priority for the American College of Physicians, which has published a new toolkit to help members advocate for prior authorization reform.

The toolkit includes information about ACP public policy positions on prior authorization reform and the advocacy ACP has done on behalf of members on this topic, along with resources for members who want to take action, said Kory Stuer, ACP associate for state health policy and advocacy.

“Members can use the toolkit to educate themselves about the policy landscape on prior authorization reform and take action to help ACP advocate for reforms both at the federal level and in their states,” they said.

Prior authorization requirements are getting worse for many physicians, with about 80 percent saying prior authorization requirements increased during the past year in a recent survey by the Medical Group Management Association, Stuer noted.

In addition, more than 90 percent of physicians surveyed by the American Medical Association reported that prior authorization requirements led to delays in patient care and that many patients experienced serious adverse events as a result of these delays.

“Prior authorization reform has also garnered bipartisan support at both the federal and state levels, so our advocacy has the opportunity to make a positive impact for physicians and their patients,” Stuer said.

There has been a lot of activity at the state level. In 2023, at least 26 bills were introduced in 16 states to reform prior authorization requirements for procedures, tests, treatments and prescriptions. Numerous ACP chapters have been actively engaged in enacting meaningful changes to prior authorization policies.

“Pennsylvania enacted a significant new law that updated the state's prior authorization laws after years of advocacy by the ACP Pennsylvania chapter and others,” Stuer noted. The new law set requirements for all insurers on how quickly they must respond to prior authorization requests and set exemptions for emergency services.

Pennsylvania built a broad coalition encompassing health organizations, hospitals, patient advocacy groups and some insurers and worked collaboratively to advocate for these changes, Stuer explained.

Some states are considering “Gold Card” legislation that would exempt physicians with specific prior authorization approval rates from prior authorization requirements on specified services. To date, Michigan, Louisiana, Texas and West Virginia have enacted Gold Card laws.

Other proposals for prior authorization reform call for: requirements on response time to requests; mandates that prior authorization requirements must be evidence-based; and requirements for insurers to publicly release data on prior authorizations.

Some proposals call for restricting insurers from requiring other administrative burdens in addition to prior authorization requirements, such as step therapy protocols. Others advocate for authorizations to continue to be valid for medication dose changes or ongoing management of chronic conditions.

“With 2024 legislative sessions starting soon, ACP will be tracking relevant state legislation and regulations across the country and is ready to support our chapters and members interested in advocating in their states,” Stuer said.

On Oct. 16, 2023, the ACP Advocates for Internal Medicine Network issued an action alert for members to advocate that prior authorization reform be included in health care legislation being considered in Congress.

More Information

The toolkit for addressing the administrative burden of prior authorization is available on the ACP website.

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