AHA, others collaborate to streamline prior authorization

Jan 17, 2018 - 03:54 PM

The AHA, America’s Health Insurance Plans, American Medical Association, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association today released a consensus statement outlining their shared commitment to improving the prior authorization process. According to the statement, the organizations will work to reduce the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices or participation in a value-based agreement with the insurance provider; regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them; improve channels of communications between insurers, providers and patients to minimize care delays and ensure clarity on requirements, rationale and changes; protect continuity of care for patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, insurance provider or prior authorization requirements; accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care. “These principles provide a good starting point for providers and health plans to work together toward continuous improvement in quality of care and health outcomes while reducing unnecessary administrative burden,” said AHA Executive Vice President Tom Nickels.

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