Suspending Prior Authorization During COVID-19 Would Help Ensure Patient Access to Needed Care

May 26, 2020

In an open letter, the Regulatory Relief Coalition (RRC) called on all health plans in the United States to suspend prior authorization requirements for both COVID-19 and non-COVID-19-related services during the novel coronavirus pandemic. The Association for Clinical Oncology (ASCO) is a member of RRC, which is a group of national physician specialty organizations advocating for regulatory burden reduction in Medicare.  

“During this time of national emergency and its immediate aftermath, we strongly encourage all health plans to waive all prior authorization requirements,” the RRC said in the letter. “By taking this action, health plans will play their part in ensuring that Americans’ access to critical health services is not delayed or denied during the current crisis and its immediate aftermath.”

Utilization management policies—which include prior authorization—are payer-imposed practices that may restrict, limit, or deny coverage for certain treatments. A 2019 survey by the American Cancer Society Cancer Action Network (ACS CAN) found that 70% or more of its physician respondents reported that utilization management techniques have a significant negative impact on their practice of medicine by limiting their ability to provide high-quality care and imposing significant administrative burdens that divert time away from direct patient care.

The open letter also cites the following among its reasons for urging health plans to suspend prior authorization during the COVID-19 public health emergency:

  • Throughout the country, practices continue to operate on significantly reduced staff. Dedicating precious resources to seeking prior authorization of urgently needed or long-delayed services is not in the best interest of patients.
  • In areas where the healthcare system is beginning to recover from the crisis sufficiently to treat non-emergent cases, providers must now provide long-delayed, medically necessary services that were postponed during the crisis. Prior authorization burdens would only further delay this care.
  • Medicaid plans have eliminated many prior authorization requirements, and the Centers for Medicare & Medicaid Services urged Medicare Advantage Plans to exercise flexibility regarding prior authorization “to facilitate access to services with less burden on beneficiaries, plans, and providers.”
  • While some health plans have lessened barriers to care by suspending some prior authorization, others are planning to increase prior authorization requirements, even though many major health plans’ responses to prior authorization requests have been significantly delayed due to COVID-19.

Read the open letter.

Lean more about utilization management practices, and bookmark ASCO in Action for news, advocacy, and analysis on cancer policy.