Why Medicare is adding prior authorization requirements as others cut back

AXIOS March 1, 2024
Maya Goldman

Medicare is taking the rare step of adding pre-treatment approval requirements before patients can get care at certain outpatient surgical facilities that have seen a sharp uptick in billings.

Why it matters: Medicare’s decision shows that it still sees prior authorization as a useful tool for controlling costs, even as the Biden administration cracks down on misuse of a practice detested by health care providers and patients.

The big picture: The Biden administration in January required Medicare Advantage insurers and other private plans to speed up prior authorization reviews, and some major insurers have also cut back following public backlash to policies potentially curbing patient access to needed care.

• The recent controversy overshadowed the purpose of prior authorization: making...

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