- CMS updates prior authorization transparency guidance in response to AMA recommendations
- While lawmakers are back in district this August, take action on key issues that need your voice
- AMA responds to NIH request for information on strengthening rigor and impact of biomedical research
- AMA submits comments urging CMS to strengthen Medicare drug price negotiation
- More articles in this issue
CMS updates prior authorization transparency guidance in response to AMA recommendations
The Centers for Medicare & Medicaid Services (CMS) recently updated its guidance on federal prior authorization (PA) transparency requirements, incorporating several recommendations the AMA made following its review of how 15 Medicare Advantage contracts implemented the reporting provisions of the 2024 Interoperability and Prior Authorization final rule (CMS-0057-F).
The review revealed a consistent pattern: Many payers appeared to comply with the rule while presenting disclosures in places and formats that made them difficult or impossible to find or use. Payers posted hundreds of pages of billing codes without plain-language descriptions, buried required disclosures behind physician or member portals and deep within plan websites, reported mathematically impossible statistics and turnaround times without units, and omitted entire categories of care from public reporting.
The AMA documented these concerns and recommended corrective action in a May 2026 letter to CMS and reiterated several of those recommendations in its June 2026 comments (PDF) on CMS-0062-P, which would extend PA transparency reporting requirements to prescription drugs.
The updated guidance addresses several of these problems by:
- Defining what it means for prior authorization information to be publicly accessible. CMS makes clear that disclosures are not publicly accessible if they are available only through password-protected portals or cannot be reached through ordinary navigation from a payer’s public-facing website.
- Clarifying that prior authorization disclosures must be understandable. CMS explicitly says lists of procedure codes without plain-language descriptions do not satisfy the requirement and recommends a single, comprehensive list organized by uniform service categories, with CPT codes, plain-language descriptions, and a machine-readable format.
- Standardizing how payers calculate reported outcomes. CMS now specifies the expected numerator and denominator for each metric, preventing payers from omitting entire categories of care from prior authorization reporting.
- Improving the accuracy and reliability of reported data. CMS clarifies that every turnaround-time metric must include a unit of time and requires median turnaround times of less than one day to be reported in hours rather than rounded to “0 days.” The agency also recommends that payers explain any data quality issue in their reporting by identifying the affected metric(s) and describing the limitation or quality concern.
As CMS moves to expand PA reporting requirements to prescription drugs, the AMA will continue working with the agency to ensure its transparency policies deliver on their promise of helping patients make informed decisions about their care, physicians navigate PA requirements, and regulators hold payers accountable for delays and denials—ultimately improving timely access to care for patients and reducing unnecessary burdens on physicians.
While lawmakers are back in district this August, take action on key issues that need your voice
With the August congressional district work period already underway, now is the time to maximize opportunities to elevate the AMA's top federal priorities impacting patients and physicians. Watch a recently recorded webinar that provides an update on the key legislative issues that need your voice and how AMA physician advocates can work to raise awareness of these priorities with their lawmakers during the remainder of the recess. Then use the 2026 recess engagement toolkit (PDF) to take action on these issues with your members of Congress while they are back in their districts.
Your grassroots efforts now can help build momentum for more extensive in-district advocacy when Congress returns this fall—contact Congress now.
AMA responds to NIH request for information on strengthening rigor and impact of biomedical research
On Aug. 18, the AMA submitted comments (PDF) to the National Institutes of Health (NIH) in response to its Request for Information on Measuring and Rewarding Scientific Impact, recommending steps to strengthen the rigor, clinical relevance, and impact of federally supported biomedical research.
Specifically, the AMA urged NIH to:
- Fund the research questions patients and physicians most need answered. NIH should solicit physician input to identify the most pressing evidence gaps in clinical practice and direct research funding to address them.
- Increase investment in comparative effectiveness research (CER) and cost-effectiveness analysis (CEA). Increased investment in CER and CEA, coupled with stronger requirements for appropriate trial comparators, would give physicians better evidence to assess the benefits, harms, and relative value of available treatments and promote high-value care.
- Strengthen methodological standards for NIH-supported research. NIH should require studies to use clinically relevant endpoints, adequate follow-up, representative populations, and care settings, and prespecified methods so physicians can rely on their findings to inform patient care.
- Strengthen and enforce data-sharing requirements. NIH should make reporting and data sharing a condition of funding so thatresearch findings can be independently tested, reused, and built upon—accelerating discovery and improving the evidence available to physicians and patients.
- Protect scientific independence and federal research investments. NIH should safeguard the integrity and continuity of federally supported research by prohibiting political interference in peer review, establishing transparent standards for decisions that depart from scientific review recommendations, protecting ongoing research from arbitrary termination, and maintaining timely annual disbursement of appropriated research funds.
The AMA will continue to advocate for federal research policies that produce rigorous, reliable evidence, accelerate scientific discovery, and improve patient care in the real world.
AMA submits comments urging CMS to strengthen Medicare drug price negotiation
On Aug. 14, the AMA submitted comments (PDF) to CMS on its proposed rule to codify policies governing the Medicare Drug Price Negotiation Program.
In the comments, the AMA reaffirmed its longstanding support for Medicare drug price negotiation and urged CMS to strengthen the proposed regulations to promote a transparent, clinically grounded process that maximizes savings for patients and the Medicare program alike.
Specifically, the AMA urged CMS to:
- Increase transparency throughout the drug negotiation process. CMS should provide enough information for physicians, patients, and the public to understand why drugs were selected, how maximum fair prices (MFPs) were determined, and how statutory factors affected the final price.
- Strengthen the use of clinical evidence and physician and patient input. When direct comparative evidence is limited, CMS should identify evidence gaps and account for uncertainty. CMS should also incorporate physician and patient input on clinically important differences between therapies that studies may not capture.
- Account for manufacturer investment, financial returns and practices that delay competition. CMS should consider taxpayer support for drug development, whether manufacturers have already recouped their investments and the use of strategies such as patent thickets and product hopping to prolong higher prices.
- Protect access to physician-administered drugs. CMS should ensure physician practices can acquire negotiated Part B drugs at the MFP rather than requiring them to finance the difference and await reimbursement, which could jeopardize access to treatment, particularly in smaller and independent practices.
As CMS finalizes implementation of the Medicare Drug Price Negotiation Program, the AMA will continue to advocate for policies that strengthen the integrity and effectiveness of the negotiation process and protect patient access to critical drugs.
