Health Affairs July 11, 2022
A recent Health and Human Services (HHS) Office of Inspector General (OIG) report and subsequent media coverage has sparked renewed debate over prior authorization, particularly as it is used by Medicare Advantage plans, which today cover 28 million Americans, nearly half of all Medicare beneficiaries. Much of the discussion, however, has focused on the process of prior authorization, such as the time and personnel involved. Meanwhile, scarce attention is paid to which specific clinical services are actually subject to prior authorization. This discrepancy amounts to a missed opportunity to advance policies that clarify and refocus prior authorization’s core purpose.
The Role Of Prior Authorization To Address Wasteful Spending
A fundamental charge of prior authorization must be to facilitate safe, evidence-based...
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