Physicians and practice staff spend hours each day dealing with utilization management programs, complex claim filings and other nonclinical activities. While some administrative requirements on a practice are expected, many are not essential.
As a result of overuse, inefficiencies and lack of transparency in these requirements, administrative hurdles can stand in the way of patients’ timely access to care as well as increase costs for physicians and their patients.
Prior Authorization and Step Therapy
Health insurers and benefit managers are increasingly requiring prior authorization and step-therapy protocols for pharmaceuticals and medical services. These requirements can delay or interrupt care, divert resources from patients and complicate medical decision-making.
The AMA is engaged at every level to reduce the harmful impact of these utilization management programs. Physician and patient advocates can draw on the materials below, including model state legislation, to promote meaningful changes to prior authorization and step therapy requirements and improve access to care.