A bill that would reform how Medicare Advantage plans use prior authorization—one of the most persistent barriers to timely, medically necessary care for patients 65 or older—has tremendous support from lawmakers.
More than half of the members of the House of Representatives—248—and a supermajority of U.S. Senators, 64, are co-sponsors of the Improving Seniors’ Timely Access to Care Act of 2025 (H.R. 3514/S. 1816).
The AMA and more than 120 national medical specialty societies and state medical associations are urging House and Senate leaders to bring the proposed legislation “to the floor and pass it without delay.”
The AMA has supported the bipartisan, bicameral legislation that has been introduced in previous Congressional sessions and even passed the House of Representatives but has fallen just short of being enacted into law. In an AMA-led sign-on letter (PDF), the organizations explain the harm that prior authorization causes patients and tell lawmakers the “time for expeditious legislative action is now.”
“Prior authorization continues to be a leading source of care delays and frustration for patients and physicians alike. It is a practice used by health plans to require pre-approval for coverage of items, services, and pharmaceuticals, often resulting in treatment delays, denials of medically necessary care, poorer patient health outcomes, and significant administrative burden,” says the letter addressed to Republican and Democratic House and Senate leaders.
Reps. Mike Kelly (R-Penn.), Suzan DelBene (D-Wash.), Ami Bera, MD, (D-Calif.) and John Joyce, MD, (R-Penn.) introduced the Improving Seniors’ Timely Access to Care Act of 2025 in the House; Sens. Roger Marshall, MD, (R-Kan.) and Mark Warner (D-Va.) are lead sponsors in the Senate.
The AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
Real harm for patients
The AMA-led letter lays out just how disruptive and costly prior authorization is for patients and physicians.
A 2024 AMA national survey (PDF) showed that:
- 93% of physicians cited care delays linked to prior authorization.
- 82% reported the tactic sometimes causes patients to abandon recommended treatment.
- 29% witnessed prior authorization leading to a serious adverse event for a patient, including hospitalization, disability or death.
A recent oncology professionals’ survey found that everyone who participated in the survey reported patients experiencing harm because of prior authorization delays. Among survey participants, 80% witnessed disease progression and 36% saw loss of life.
“These findings highlight the urgent need for congressional action to protect patients from bureaucratic barriers to care,” says the AMA-led letter.
Further, the letter explains, Medicare Advantage patients are experiencing prior authorization delays that traditional Medicare beneficiaries wouldn’t see.
The letter highlights a 2022 Department of Health and Human Services’ (HHS) inspector general’s report, which found that 13% of prior authorization requests that were ultimately denied for Medicare Advantage patients would have been approved had the patient been covered under traditional Medicare. That same report also found that 18% of payment requests that Medicare Advantage plans denied met standard Medicare coverage and billing rules.
How this legislation helps
The Improving Seniors’ Timely Access to Care Act would, among other things, simplify and accelerate prior authorization decisions and promote transparency. The bill directs plans to base requirements on evidence-based criteria and review those requirements annually to eliminate unnecessary barriers to care.
“By codifying these patient protections and remaining consistent with the CMS’ 2024 Interoperability and Prior Authorization final rule, the bill would reduce administrative waste and improve patients’ outcomes and make certain that medical decisions are timely, transparent and clinically sound,” the letter says.
The legislation also would:
- Require Medicare Advantage plans to implement electronic prior authorization programs that follow newly developed federal standards that seamlessly integrate into physicians’ electronic health systems.
- Mandate that plans report to the Centers for Medicare & Medicaid Services (CMS) how often they use prior authorization and the rate of approvals and denials.
- Provide a pathway for CMS to study and institute real-time decisions for routinely approved items and services.
- Clarify CMS’ authority to establish timeframes for electronic prior authorization request approvals, including expedited deadlines for emergent services.
- Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the prior authorization process.
The bill incorporates the major elements of a 2018 consensus statement (PDF) that the AMA and leading hospital, medical group, health plan and pharmacy organizations created.
Learn more about the critical changes that the AMA says must be made to prior authorization, including speeding up payers’ response time and cutting down on the sheer volume of prior authorizations required.
