Delegates to the 2025 AMA Interim Meeting took several actions that will strengthen the AMA’s efforts to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
Prior authorization originally emerged as a way to restrain excess medical costs, but it’s increasingly been used on pharmaceutical and procedural medical care that have nominal costs, according to a resolution adopted at the Interim Meeting.
AMA policy already called for the AMA to advocate that “low-cost noninvasive procedures that meet existing standard Medicare guidelines should not require prior authorization,” notes the resolution, introduced by the AMA Organized Medical Staff Section.
Under the resolution that delegates adopted, the AMA will “advocate that low-cost medications and procedures should not require prior authorization.”
Prior authorizations shouldn’t have expiration dates
There is no accepted scientific medical rational for placing time limits on access to care selected in accordance with peer-reviewed medical literature, yet arbitrary time limits on prior authorizations for diagnostic and therapeutic interventions are one of the many tools payers use to delay and deny access to care, says a resolution introduced by the New York delegation.
But, whether for medical or nonmedical reasons, there are times when completing preauthorized care within the arbitrary frame isn’t possible. To help ensure that patients aren’t harmed by these arbitrary limits and to reduce added insurer administrative hurdles for physicians, the AMA will:
- Advocate changes in state legislation and regulatory policy to prohibit health insurers in any state, including Medicaid plans, from establishing time limits on duration of preauthorization for care of less than one year.
- Seek similar changes in federal legislation and policies to prohibit Medicare Advantage, Medicaid, Veterans Affairs Community Care, and Employee Retirement Income Securement Act of 1974 (ERISA) plans from establishing time limits on preauthorizations for care of less than one year.
Keep score of how payers do on prior auth
In a separate action, delegates aimed to boost transparency on prior authorization. The Centers for Medicare & Medicaid Services (CMS) has finalized a rule requiring Medicare Advantage plans to respond to physician requests for prior authorization within certain time frames and for plans to publicly report the number of services subject to prior authorization, the number of services approved, denied and overturned on appeal and the time frames.
To continue a trend toward public scorecards on the impact of prior authorization, the AMA will:
- Continue to lead the advocacy effort and assist state medical associations with the implementation of timely, non-aggregated public reporting by private and public plans that engage in prior authorization related to the services subject to prior authorization, the number of services approved, denied and overturned on appeal, and the time frames for responding to requests for authorization and paying physician claims.
- Work with interested organizations in the development and publication of public and private plan scorecards related to prior authorization approvals, denials, appeals and the time frames for responding to requests for authorization and processing physician payments to better inform patients, physicians and purchasers of insurance.
Show how payers profit from prior auth
With Medicare Advantage and commercial health plans potentially financially benefiting from delays in authorizing care and processing claims, increased transparency about the companies’ financial gains can empower patients, physicians, employers and policymakers to demand accountability and reform, says a resolution introduced by seven state delegations.
In an effort to promote transparency, delegates adopted policy to “support efforts to investigate and publicize the financial benefit and profit to commercial insurers, and Medicare and Medicaid health plans that inappropriately use prior authorization to unnecessarily delay care for patients and payments to physicians.”
Read about the other highlights from the 2025 AMA Interim Meeting.
