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CMS Administrator Seema Verma has tasked her Patients Over Paperwork team with exploring what CMS can do to improve Prior Authorization (PA) burdens as part of the eighth topic addressed under the initiative. In addition, stakeholders like ISASS and other medical specialty societies have submitted input in writing on the issue.

ISASS has been a signatory to an AMA taskforce report on Prior Authorization impacts and continues to work closely with the AMA and other medical specialties. These stakeholders submitted a letter to Administrator Verma on September 19.

ISASS and other signatories are concerned that the CMS initiatives are too heavily focused on automation and technology and are not addressing other areas of importance as outlined in the Prior Authorization and Utilization Management Reform Principle Statement. The statement emphasizes five areas for CMS to focus on, all of equal importance.

  • Selective application of PA to only “outliers”
  • Review/adjustment of PA lists to remove services/drugs that represent low-value PA
  • Transparency of PA requirements and their clinical basis to patients and physicians
  • Protections of patient continuity of care
  • Automation to improve PA and process efficiency

Read the Prior Authorization and Utilization Management Reform Principle Statement

Read the Medical Specialty Society Letter