AMA, AHA release prior authorization principles

A coalition that includes the American Medical Association (AMA), American Hospital Association, and 15 other healthcare organizations is calling for an industry-wide reassessment of prior authorization programs.

In an effort to reduce barriers to care imposed by prior authorization requirements  created by insurers’ prior authorization requirements, the coalition developed 21 principles that the healthcare industry can use when reassessing its prior authorization processes for procedures, tests, devices, and drugs.

The Prior Authorization and Utilization Management Reform Principles are based on the following five categories:

•     Clinical validity
•     Continuity of care
•     Transparency and fairness
•     Timely access and administrative efficiency
•     Alternatives and exemptions

The coalition developed the 21 principles using data from the AMA’s December 2016 Prior Authorization Physician Survey, which was sent out to 1,000 physicians. The survey revealed that nearly 75% of physician respondents believed prior authorizations were burdensome.