On Jan. 18 the American Medical Association (AMA) released a Consensus Statement on Improving the Prior Authorization Process, together with the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, the Blue Cross Blue Shield Association, and the Medical Group Management Association.

Based on a recent AMA advocacy campaign on Prior Authorization and Utilization Management Reform Principles, an effort that officially received AASM support in September 2017, the consensus statement outlines five key areas of the prior authorization process that are in need of reform:

  • Selective application of prior authorization
  • Prior authorization program review and volume adjustment
  • Transparency and communication regarding prior authorization
  • Continuity of patient care
  • Automation to improve transparency and efficiency

According to the statement, the signed-on organizations wrote:

“The prior authorization process can be burdensome for all involved—health care providers, health plans, and patients. Yet, there is wide variation in medical practice and adherence to evidence based treatment. Communication and collaboration can improve stakeholder understanding of the functions and challenges associated with prior authorization and lead to opportunities to improve the process, promote quality and affordable health care, and reduce unnecessary burdens.”

For a further discussion on issues concerning prior authorization in sleep medicine, please contact AASM advocacy staff by email at policy@aasm.org or by phone at (630) 737-9700.