KFF Health News January 18, 2024
More than a year after it was initially proposed, the Biden administration announced a final rule yesterday that will change how insurers in federal programs such as Medicare Advantage use prior authorization — a long-standing system that prevents many patients from accessing doctor-recommended care.
“When a doctor says a patient needs a procedure, it is essential that it happens in a timely manner,” Health and Human Services Secretary Xavier Becerra said in a statement. “Too many Americans are left in limbo, waiting for approval from their insurance company.”
Sometimes called pre-authorization or pre-certification, prior authorization requires patients and their doctors to seek approval from insurers before proceeding with a treatment, test or medication. Insurer payment is often contingent upon...
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