Coalition Issues Statement on Prior Authorization Reform

Last week, an AMA-led coalition including the North Carolina Medical Society (NCMS) issued a Consensus Statement outlining the shared commitment to industry-wide improvements to streamline the prior authorization approval processes to enhance patient access to timely, appropriate care and minimize potential disruptions. The statement is the result of more than a year’s work including a survey of physicians, including NCMS members, on their impressions of prior authorization (review the results here) and follows a series of Prior Authorization and Utilization Management Reform Principles.

According to the Consensus Statement, health care leaders will work together to:

  • Reduce the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with the health insurance provider.
  • Regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them.
  • Improve channels of communication between health insurance providers, health care professionals and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale and changes.
  • Protect continuity of care for patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, health insurance providers or prior authorization requirements.
  • Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

The coalition is committed to continued collaboration to improve the prior authorization process. Visit the Prior Authorization page on the AMA website to stay up to date on this reform initiative.


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