Bipartisan Group of More Than 100 Lawmakers Urges Improvements to Prior Authorization Under Medicare Advantage

October 22, 2018

A bipartisan group of more than 100 members of the U.S. House of Representatives signed a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma urging the Agency to review and improve prior authorization practices under Medicare Advantage (MA). The letter, led by Rep. Ami Bera, MD (CA-7), and Rep. Phil Roe, MD (TN-1), cites concerns that MA beneficiaries may be encountering barriers to care due to “onerous and often unnecessary prior authorization requirements.”

Specifically, the letter urges CMS to:

  • Collect data on the scope of prior authorization practices — including denial, delay, and approval rates
  • Issue guidance to MA plans to dissuade the widespread use of prior authorization and to provide direction to the health plans to increase transparency, streamline prior authorization, and minimize the impact on beneficiaries
  • Ensure that prior authorization practices do not create inappropriate barriers to care for Medicare enrollees

During ASCO’s recent Advocacy Summit on Capitol Hill, ASCO members urged lawmakers to sign this letter to CMS, which aligns to the society’s policy statement on utilization management strategies for cancer drugs. ASCO’s policy statement makes specific recommendations to help ensure that the policies payers use to control the use of anti-cancer drug therapies, which include prior authorization requirements, promote rather than hinder patient access to high-quality, high-value cancer care. ASCO applauds the lawmakers who signed the letter to CMS and will continue to advocate for improvements to utilization management strategies.

Read the full letter

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