To combat what it calls “proliferating, onerous prior authorization [PA] requirements that are delaying and denying necessary care for patients and adding administrative burdens for physicians,” the AMA's House of Delegates has approved policies designed to create improved transparency and accountability from insurers. The policies approved at its annual meeting include:

• Insurer accountability when PAs harm patients. Because the bureaucratic PA policies imposed by health plans often conflict with evidence-based clinical practice and jeopardize quality care, the AMA will advocate for greater legal accountability when these policies negatively impact patients. Further, the AMA says it will lobby to ensure that increased legal accountability “is not precluded by clauses in beneficiary contracts that may require pre-dispute arbitration for prior authorization determinations or place limitations on class action.”
• Transparency for PA denials. To correct the insurer denial process that the AMA calls “notoriously opaque, complex, and inconsistent,” the group will continue its efforts to require insurers to provide detailed explanations when PAs are denied.
• Continued support for real-time prescription benefit tools (RTBTs) that allow physicians access to patient drug coverage information at the point of care in their electronic health records, streamlining access to care and avoiding unexpected delays and denials by confirming insurer-approved therapies or providing therapeutically-equivalent alternative treatments that do not require the insurer’s PA.

The AMA’s House of Delegates is the group’s policy-making body, composed of physicians, residents and medical students representing every state and medical specialty. For more information, click here.