A bill supported by a coalition of physician specialty organizations was introduced in the House of Representatives this week to alleviate the growing use of prior authorizations in Medicare Advantage. At the same time, the group released survey results saying that PAs are increasing physician burdens and leading to delays in patient care.
A bill supported by a coalition of physician specialty organizations was introduced in the House of Representatives this week to alleviate the growing use of prior authorizations (PA) in Medicare Advantage (MA). At the same time, the group released survey results saying that PAs are increasing physician burdens and leading to delays in patient care.
The bipartisan legislation would require CMS to regulate the use of PAs in MA plans. It would define a process to make real-time decisions for services that are routinely approved. These plans would also be required to offer an electronic PA process and report to CMS on how extensively they use prior authorization, as well as how often they approve or deny medications and services.
The Improving Seniors' Timely Access to Care Act of 2019 (HR 3107) is sponsored by Representatives Suzan DelBene, D-Washington; Mike Kelly, R-Pennsylvania; Roger Marshall, R-Kansas; and Ami Bera, D-California.
“For far too long, patients have faced unnecessary and unreasonable care delays due to insurers’ overzealous use of prior authorization,” said Paula Marchetta, MD, MBA, president of the American College of Rheumatology (ACR), in a statement. “This practice creates significant burdens for physicians and can put patients’ health in jeopardy. We applaud congressional leaders for standing up to ensure America’s Medicare beneficiaries are able to get the care they need and deserve.”
The ACR is part of the Regulatory Relief Coalition, which also released a national survey of 1602 physicians detailing the effect of PAs on patients and physicians. According to the survey, 87% of physicians report that PA has a significant (40%) or somewhat (47%) negative impact on patients’ clinical outcomes. Nearly one-third of physicians surveyed said their patients often abandon treatment due to prior authorization.
Nearly 75% reported that during the past 5 years, stable patients had been asked to switch medications by a health plan for nonmedical reasons.
Most physicians (74%) said it takes between 2 to 14 days to obtain a PA, but for 15%, this process can take from 15 to more than 31 days.
In addition, 84% of survey respondents said that the regulatory burdens associated with prior authorization have significantly increased over the past 5 years, with half of all practices reporting 11 or more requests per week.
Although most PAs are eventually approved, the use of the so-called “peer-to-peer” process to obtain a PA seems to be growing; nearly 20% of respondents experience this requirement for 26% to 75% or more of their services. An American Medical Association survey released earlier this year found similar concerns with the use of PAs. Another report on a survey of health plan benefit sponsors found that many sponsors are using PA to encourage the use of biosimilars in employer-based plans.
Besides ACR, the other organizations involved in the coalition are the American Academy of Neurology, American Academy of Ophthalmology, American Association of Neurological Surgeons, Congress of Neurological Surgeons American College of Cardiology, American College of Surgeons, and the American Urological Association.
The bill is also supported by the American Medical Association, American Gastroenterological Association, American Society of Clinical Oncology, Alliance for Specialty Medicine, American College of Physicians, Change Healthcare, Medical Group Management Association, and others.
Julie Reed: Why 2024 Is Important for Biosimilars
April 17th 2024Julie Reed, executive director of the Biosimilars Forum, showcases how the biosimilar industry is expected to develop throughout 2024, including major policy changes and hope for continued improvement in market share for adalimumab biosimilars.
A New Chapter: How 2023 Will Shape the US Biosimilar Space for 2024 and Beyond
December 31st 2023On this episode of Not So Different, Cencora's Brian Biehn and Corey Ford take a look back at major policy and regulatory advancements in 2023 and how these changes will alter the space going forward.
BioRationality: Removing the Misconceptions Surrounding Interchangeability
April 15th 2024Sarfaraz K. Niazi, PhD, outlines the current state of interchangeable biosimilars in the US and policy changes needed to clear up misconceptions surrounding the meaning behind interchangeability designations.
What AmerisourceBergen's Report Reveals About Payers, Biosimilar Pricing Trends
May 28th 2023On this episode of Not So Different, Tasmina Hydery and Brian Biehn from AmerisourceBergen discussed results from a recent survey, that were also presented at Asembia 2023, diving into the payer perspective on biosimilars and current pricing trends across the US biosimilar industry.
Rising Biosimilar Adoption for an Italian Payer Will Benefit National Health Care System, Patients
April 9th 2024Data from 2021 and 2022 indicates increasing biosimilar use in an Italian health care company, with potential for full adoption in the future, benefiting both the National Health System and citizens through efficient and sustainable health care policies.
Review Highlights Most Popular European Policies to Boost Biosimilar Uptake
April 3rd 2024Although tender systems are a common strategy to encourage biosimilar utilization across Europe, policies like automatic substitution are rarely utilized, according to a systematic review of European policies and biosimilar uptake.
Julie Reed: Why 2024 Is Important for Biosimilars
April 17th 2024Julie Reed, executive director of the Biosimilars Forum, showcases how the biosimilar industry is expected to develop throughout 2024, including major policy changes and hope for continued improvement in market share for adalimumab biosimilars.
A New Chapter: How 2023 Will Shape the US Biosimilar Space for 2024 and Beyond
December 31st 2023On this episode of Not So Different, Cencora's Brian Biehn and Corey Ford take a look back at major policy and regulatory advancements in 2023 and how these changes will alter the space going forward.
BioRationality: Removing the Misconceptions Surrounding Interchangeability
April 15th 2024Sarfaraz K. Niazi, PhD, outlines the current state of interchangeable biosimilars in the US and policy changes needed to clear up misconceptions surrounding the meaning behind interchangeability designations.
What AmerisourceBergen's Report Reveals About Payers, Biosimilar Pricing Trends
May 28th 2023On this episode of Not So Different, Tasmina Hydery and Brian Biehn from AmerisourceBergen discussed results from a recent survey, that were also presented at Asembia 2023, diving into the payer perspective on biosimilars and current pricing trends across the US biosimilar industry.
Rising Biosimilar Adoption for an Italian Payer Will Benefit National Health Care System, Patients
April 9th 2024Data from 2021 and 2022 indicates increasing biosimilar use in an Italian health care company, with potential for full adoption in the future, benefiting both the National Health System and citizens through efficient and sustainable health care policies.
Review Highlights Most Popular European Policies to Boost Biosimilar Uptake
April 3rd 2024Although tender systems are a common strategy to encourage biosimilar utilization across Europe, policies like automatic substitution are rarely utilized, according to a systematic review of European policies and biosimilar uptake.
2 Commerce Drive
Cranbury, NJ 08512