Prioritize Prior Authorization Reforms In Medicare Advantage

For the first time, more Medicare enrollees received their Medicare benefits through a Medicare Advantage (MA) plan last year than through Traditional Medicare. We saw first-hand at the Center for Medicare how this ongoing shift towards MA has major implications for people with Medicare as well as providers, health plans, taxpayers, and the United States health care system. But of all the issues we navigated, none was raised more than concerns about utilization management, including prior authorization (UM/PA) in MA.

We heard from a full range of bipartisan stakeholders about three fundamental challenges related to the current state of utilization management: 1) barriers to access for medically necessary care, 2) a huge administrative burden on the U.S. health...