Statement attributable to: 
Bruce A. Scott, M.D.
President, American Medical Association

“It’s good news that UnitedHealth Group is finally looking for ways to simplify and accelerate their prior authorization process. But seven years after a consensus statement (PDF) in which the insurance industry agreed to key reforms to improve this onerous process—and with the burden and outcomes only worsening—patients, physicians and policymakers are looking for specifics and meaningful, impactful changes that will break down unnecessary roadblocks and keep medical decisions between patients and physicians.

“Improving the prior authorization process requires meaningful actions like significantly reducing the volume of requirements, using transparent and evidenced-based clinical criteria, ensuring that qualified physicians are the only ones making denials, and requiring that decisions are made within hours, not days or weeks. Moreover, these reforms must be made across all markets, including self-funded plans, and laws must be adhered to when they are in place. In survey after survey (PDF), physicians have said prior authorization barriers have led to life-threatening events for patients and mountains of paperwork that waste staff time and fuel a physician burnout crisis. Prior authorization programs are optional for plans, but accessing healthcare is not optional for patients. Health plans need to leave the medical decision-making up to physicians and their patients.

“While talking about forward progress on this issue is a positive step, it must be followed by substantive actions. A new year demands a new approach—enough with promises that nibble around the edges of the problem and benefit few if any. Our patients deserve broad and meaningful prior authorization reforms, and we urge health insurers to get on board with immediate actions.”