Momentum builds to fix prior authorization

October 05, 2019


Dr. Paul Harari, a radiation oncologist, likened it to torture. The interminable back and forth. The outdated fax machines. Wasting time on the phone to convince a health plan’s medical director that a cancer treatment the plan denied is the right way to go when he could be off taking care of his patients.

Harari’s frustration with prior authorization is typical among doctors and other clinicians, who say they are increasingly burdened with onerous requirements imposed by health insurers and pharmacy benefit managers to seek advance approval for procedures and medications. They claim the requirements harm patients in the name of boosting insurers’ profits.

“Cancer patients are super anxious about delays and that’s what we continue to see more and more of with prior authorization: delays in getting recommended treatment underway,” said Harari, chairman of the human oncology department at the University of Wisconsin School of Medicine and Public Health in Madison.

Health insurers and other payers insist prior authorization is a tool used sparingly to ensure patients are getting the right treatment in the right place; reducing costs is secondary. They contend it’s not a means to deny claims, as HHS’ Office of Inspector General has suggested. But they do admit the cumbersome process is a pain, and some insurers are at the center of collaborative industry initiatives to modernize the process.

Read the full article here.