prior authorization

September 30, 2019

CMS Receives Input on Prior Authorization Regulations

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 […]
August 28, 2019

CMS Seeks Input From Physicians and Practices on Impact of Prior Authorization

Centers for Medicare and Medicaid Services 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. They are conducting many listening sessions with various stakeholders over the next few weeks, including a wide range of providers and health plans, to gather information on burdens and suggestions on what CMS can do on this issue. They are also visiting practices to observe the PA process in action. In this effort, CMS is looking for data on PA. They are particularly interested in the following data points in advance of taking meaningful action: Practice costs to complete PA tasks, particularly […]
June 25, 2019

CMS Issues a Proposed Rule to Update E-prescribing Standards To Reduce Provider Burden and Expedite Patient Access To Needed Medications

On June 17, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve patients’ access to necessary medications by updating the prior authorization process for Medicare Part D, the program that provides coverage for prescription drugs that beneficiaries pick up at a pharmacy counter. The prior authorization process requires that providers supply additional clinical information to verify that the medication can be covered under the Medicare Part D benefit. The process is intended to promote better clinical decision-making and help ensure that patients receive medically necessary prescription drugs. The proposed rule would update the Part D e-prescribing program by adopting standards that ensure secure transmissions and expedite prior authorizations. Under the proposed changes, clinicians would […]