The time-wasting, care-delaying, shortsighted health plan cost-control process known as prior authorization is long overdue for major fixes. At its Annual Meeting in Chicago this week, the House of Delegates (HOD) acted to strengthen the AMA’s fight to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
Delegates took steps aimed at insurance company prior authorization practices. These included actions directing the AMA to:
- Oppose health insurance plan policies that require prior authorization for in-person visits with a physician.
- Advocate federal and state legislation that minimizes the impact of prior authorization requirements and payer-specific formulary tiering policies for medications during transitions or lapses in insurance coverage.
- Collaborate with relevant stakeholders to develop and promote best practices for implementing medication continuity policies across different insurance plans and health care systems.
The HOD adopted new policy to support greater “financial transparency of Medicare Advantage plans, including mandated public reporting of prior authorization practices, claim denials, marketing expenses, supplemental benefits and provider networks.”
Also at the Annual Meeting, delegates directed the AMA to:
- Actively and urgently generate a prior authorization database collecting and analyzing data including metrics reflecting denial rates, care delays, impact on patient care, and associated cost adversely affecting patients and physicians across major health care insurers.
- Strengthen and expand the existing public awareness campaign, including—but not limited to—social media, print media and editorials to highlight the negative impacts of abusive and obstructive prior authorization requirements on patient care, and educate physicians and patients on their rights and available resources.
Why change is so badly needed
These moves build on the AMA’s regulatory and legislative advocacy on prior authorization. Notably, the AMA recently sent a letter (PDF) to Mehmet C. Oz, MD, the new administrator of the Centers for Medicare & Medicaid Services, to let him know that the AMA was “eager to meet” and “serve as a resource” on how to address prior authorization burdens.
The AMA also continues to support H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act of 2025. The bipartisan bill would help Medicare patients avoid unnecessary care delays by requiring appropriate specialty physicians to review.
More than one-quarter of the 1,000 physicians the AMA surveyed (PDF) in late 2024 reported that prior authorization has led to a serious adverse event for a patient in their care, including 8% who said prior auth led to a patient’s disability or permanent bodily damage, congenital anomaly or birth defect or death.
Explore why the AMA is fighting to fix prior authorization and learn more about the critical changes that must be made to fix prior authorization.
Patients, doctors and employers can learn more about reform efforts and share their personal experiences with prior authorization at FixPriorAuth.org.
Read about the other highlights from the 2025 AMA Annual Meeting.
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