Prior Authorization

Prior authorization reform initiatives

2 Min Read

Prior authorization is a cost-control process requiring health care providers to qualify for payment by obtaining approval from health insurers before performing a service.

The AMA believes that prior authorization is overused and existing processes present significant administrative and clinical concerns.

The AMA’s multifaceted approach to the prior authorization challenge includes research, practice resources and reform resources

You are why we fight

The AMA is your powerful ally, focused on addressing the issues important to you, so you can focus on what matters most—patients.

An AMA-convened workgroup of 17 state and specialty medical societies, national provider associations and patient representatives developed best practices for prior authorization and other utilization management requirements by identifying the most common provider and patient concerns.

Download the Prior Authorization and Utilization Management Reform Principles (PDF).

The Prior Authorization and Utilization Management Reform Principles are 21 principles that address the following areas:

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

See the 100+ additional stakeholders that have signed on in support

Members save on auto & transportation

  • Thousands of free CME opportunities to fulfill state requirements
  • A powerful voice fighting for you during uncertain times
  • Research, resources, events and more from the largest physician organization

The release of the 21 prior authorization reform principles initiated meaningful discussions with the health insurance industry about reducing prior authorization burdens.

Download the Consensus Statement on Improving the Prior Authorization Process (PDF). 

These discussions led to the development of the Consensus Statement on Improving the Prior Authorization Process—created by the AMA, American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Pharmacists Association (APhA), BlueCross BlueShield Association (BCBSA) and Medical Group Management Association (MGMA).

In December 2021, the AMA surveyed 1,000 practicing physicians regarding their experience with prior authorization. The survey results revealed that prior authorization still poses significant challenges for both physicians and patients, and that many of the reforms agreed to in the Consensus Statement have yet to be widely implemented by health plans.

Download the Industry checkup: Measuring progress in improving prior authorization (PDF). 

Stay up to date on prior authorization improvements

Get the latest news on the AMA’s fight to eliminate care delays, patient harm and practice hassles.

Prior authorization subscribe

FEATURED STORIES

Group of paper planes with one diverging

How to cultivate physician leaders—and head off doctor burnout

| 5 Min Read
Physician in a telehealth appointment

With virtual program at Ochsner Health, 70% of patients skip the ED

| 5 Min Read
Doctor holding patient's hand

How to support physicians facing trauma

| 6 Min Read
Taking a nap on a couch

What doctors wish patients knew about taking naps

| 10 Min Read