Prior Authorization

PAI submits comment letter to CMS urging more transparent, speedy prior authorization
PAI recognizes and appreciates the Agency’s efforts to streamline prior authorization processes and reduce physician burden. Not only is prior authorization—in its current state—burdensome, unpredictable, and time-consuming for physicians, it also causes harmful delays in patients receiving the care they need. While PAI supports the key provisions in the proposed rule, we strongly urge CMS to further enhance the rule’s impact through additional provisions to support adoption by physicians and strengthen the rule’s transparency requirements, including requiring transparency around the specific clinical guidelines used in PA determinations. PAI also recommends additional reporting by payers on metrics that will inform efforts to further streamline and speed PA processes (e.g., through “real time” determinations where appropriate) and protect patients from unnecessary delays in care. This will also support monitoring and enforcement, which PAI views as an important component to ensuring compliance with these requirements.

CMS Proposed Rule on Modifications to Prior Authorization:
PAI’s letter to CMS supports the goal of streamline prior authorization policies and encourages CMS to adopt a series of recommendations to move even further towards reforming the prior authorization process, ensuring that physicians are able to implement successful patient-centered care models.