ASCO joined 370 health care groups in urging members of the U.S. House of Representatives to support the Improving Seniors’ Timely Access to Care Act (H.R. 3107). The bipartisan bill would help protect patients from unnecessary care delays by streamlining and standardizing prior authorization under Medicare Advantage (MA) and providing program oversight and transparency for MA beneficiaries.
“We continue to hear concerns from our members that prior authorization requirements are causing care delays for people with cancer,” said ASCO President Howard A. “Skip” Burris III, MD, FACP, FASCO. “Treatment delays are particularly harmful for patients with cancer because they can lead to serious complications and irreversible disease progression. The Improving Seniors’ Timely Access to Care Act takes an important first step toward addressing this problem by streamlining prior authorization practices and providing needed oversight to help ensure patients with cancer get the care they need when they need it.”
The bill would improve the prior authorization process for MA plans by requiring “real time” authorizations for routinely approved services, as well as:
- Creating an electronic prior authorization process
- Requiring plans to report to the Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials
- Requiring plans to adopt transparent prior authorization programs that are reviewed annually, adhere to evidence-based medical guidelines, and promote continuity of care to minimize care disruptions
- Holding plans accountable for making timely prior authorization determinations and to provide rationales for denials
- Prohibiting additional prior authorization for medically-necessary services performed during a surgical or invasive procedure that already received, or did not initially require, prior authorization
The Improving Seniors’ Timely Access to Care Act was introduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall (R-KS), and Ami Bera (D-CA). ASCO previously endorsed the legislation and applauds Reps. DelBene, Kelly, Marshall, and Bera, for their commitment to this issue. Nearly 30 ASCO State Affiliates also signed the letter to the House.
ASCO remains committed to the principles and recommendations conveyed in its 2017 policy statement on utilization management, and to working with policymakers and stakeholder groups to develop and implement policies that benefit patients with cancer.
Read the letter.