Urge your lawmakers to enact legislation that will streamline prior authorization requirements in the Medicare Advantage program.

The Background:  

A recent survey of ASCO members found that nearly all participants report their patients have experienced harm due to prior authorization caused by:

• Delays in treatment (96%)
• Patients being forced onto a second-choice therapy (93%)
• Denied therapy (87%)
• Increased out-of-pocket costs (88%)

ASCO members and State Affiliates continue to rate prior authorization as a top concern.

The Ask: 

ASCO and the broader medical community are asking Congress to take steps that will streamline the prior authorization process within the Medicare Advantage program, including:

• Creating an electronic prior authorization process.
• Holding plans accountable for the timeliness of determinations.
• Improving transparency by requiring plans to report to the Centers for Medicare and Medicaid Services (CMS) on the extent of their prior authorization use.
• Prohibiting additional prior authorization for added medically necessary services performed during an invasive procedure that already received prior authorization.

Why it Matters: 

Prior authorization requirements, which often take weeks to secure approval, can lead to potentially irreversible disease progression. These requirements also place a significant administrative burden on clinicians and their staff, who spend hours each week securing approvals which, consequently, hinders their ability to spend that time with patients.

Urge your lawmakers to enact legislation that will streamline prior authorization requirements in the Medicare Advantage program.