On Monday, the Blue Cross Blue Shield Association, AHIP, and 48 insurance carriers announced a new plan aimed at reducing the administrative burden of prior authorization for healthcare providers. The initiative will be rolled out over the next two years and includes commitments to decrease the number of prior authorization requests, improve standardization and response times, and enhance coordination with healthcare providers regarding the process.
This is not the first time insurers have pledged to address concerns about prior authorization. In 2018, payers signed a consensus statement with organizations such as the American Medical Association (AMA), the American Hospital Association, and other groups representing pharmacists and medical managers. That agreement included several commitments intended to reduce administrative hurdles for physicians and patients.
Despite these earlier promises, surveys from the AMA indicate that doctors still view prior authorization as a significant obstacle to patient care. By 2022, the AMA stated: “Insurance companies are not following through with agreed upon prior authorization reform,” referencing continued negative survey results from physicians. Current data show that many doctors continue to report serious problems caused by prior authorization requirements.
U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz have expressed optimism about this latest effort. Dr. Oz told Modern Healthcare: “There’s violence in the streets over these issues” and “Americans are upset about it.” He suggested that increased participation among insurers, public dissatisfaction with current practices, and new commitments to interoperability may make this attempt more successful than previous ones.
The Florida Medical Association (FMA) has indicated it will monitor whether insurers’ renewed commitment leads to meaningful changes or simply serves as justification against further regulation. The FMA stated its intention to advocate for legislative measures such as mandatory response time limits for prior authorization requests and bans on retroactive denials if voluntary reforms prove insufficient.
