The AMA continues its efforts to bring greater prior authorization transparency and accountability on the part of payers. At their annual meeting in June, the AMA reiterated the fact that payers keep this process opaque and overly complex is no accident. A majority of physicians in an AMA survey said it is difficult to determine whether a particular prescription medication or medical service even requires prior authorization. Denials are issued without explanation or justification, without information on how the denial can be appealed, and with no guidance whatsoever on alternative treatments options. Physicians and their patients are left in the dark, with adverse outcomes too often the result. Causing such harm should bear a price, and the AMA will support legal consequences for insurers when their prior authorization processes disrupt medically necessary care and lead to patient harms.
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