By Matthew Hawley & Jonathan Starr PharmD – A patient receives automatic refills from a specialty pharmacy for a drug he no longer uses and ends up stockpiling $1 million worth of medication. A pharmacy miscalculates the number of units of a specialty drug prescribed for a patient, resulting in a claim that is $16,000 higher than necessary, yet the claim is paid for by insurance.
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AMA survey shows, health insurer industry continues to show apathetic or ineffectual follow-through on mutually accepted reforms despite mounting evidence that insurer-imposed authorizations for drugs and medical services can be a hazardous and burdensome administrative obstacle to patients.
By Alex Baker & Michael Wittie – In January 2022, ONC issued a Request for Information that sought public input on the ONC Health IT Certification Program and how it could incorporate standards, implementation specifications, and certification criteria related to electronic prior authorization.
By Scott Overholt – Payer-required administrative tasks are a burden most providers know all too well. They are a daily source of frustration, diverting time from mission-critical work and often delaying patient care. Legislation impacting audit and authorization processes is in constant flux, only increasing confusion about payer requirements and regulations.
By Richard Cohan – Since the 1960s, medical prior authorizations have established a system of checks and balances that help control the costs of medication, services, and procedures. While much has changed since those days, many challenges—such as cumbersome manual processes for payers and providers and delays in care for patients—have remained the same.
At the height of the COVID-19 pandemic, physicians reported being bedeviled by unnecessary, bureaucratic obstacles that the health insurance industry pledged to reduce three years ago. The data highlights the urgent need for new bipartisan legislation introduced last week in the House, the Improving Seniors’ Timely Access to Care Act.
As new cases of COVID-19 in the United States were peaking in late 2020, most physicians reported that health plans continued to impose bureaucratic prior authorization policies that delay access to necessary care and sometimes result in serious harm to patients, according to new survey results issued by the AMA.
By David Shelton – A staggering 90% of physicians say manual prior authorizations are a concern, according to the 2019 CAQH Index. Further magnifying the current situation are payers’ intentions to increase prior authorization requirements for even more services in the near future.
By Krithika Srivats – Providers view prior authorization as a manual, burdensome, and laborious process, mostly because of process missteps such as lack of clinical data integration, inconsistency in data exchange standards, and differing policies among payers.