Coalition urges insurers to apply reform principles to current prior authorization programs
MONDAY, June 5, 2017 (HealthDay News) — A new policy addresses some of the problematic issues associated with prior authorizations, according to a report published by the American Academy of Family Physicians (AAFP).
In April, the AAFP Board of Directors voted to adopt an official AAFP policy on prior authorizations, which describes the importance of addressing this issue for family physicians.
The policy notes that prior authorizations create significant barriers for the delivery of timely and evidence-based care to patients. In order to deal with this process, prior authorizations should be standardized and universally electronic throughout the industry. In most circumstances, family physicians should have the freedom to prescribe and order what their patients need, without prior authorizations, using appropriate clinical knowledge, training, and experience. An evidence-based, transparent, and efficient system is necessary to ensure timely access and optimal patient outcomes for those instances where prior authorizations are clinically relevant. Prior authorizations should not be required for family physicians who contract with health plans, or when physicians prescribe generic medications for their patients. Step therapy protocols can be particularly problematic and should not be mandatory for patients already on a course of treatment.
According to the report, “the Academy’s recent action on prior authorizations came on the heels of a call by the AAFP and a coalition of 16 other organizations earlier this year to reform prior authorization and utilization management requirements.”
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