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  • Washington Highlights

    AAMC, Leading Medical Societies Support Proposed Prior Authorization Reforms


    Gayle Lee, Director, Physician Payment & Quality
    For Media Inquiries

    The AAMC joined 118 leading medical societies in a letter to the administrator of the Centers for Medicare & Medicaid Services (CMS) supporting prior authorization reforms included in a proposed rule on Medicare Advantage (MA) and the Medicare prescription drug benefit. The letter urged the CMS to finalize provisions ensuring that MA beneficiaries have access to the same items and services as they would under traditional Medicare and that prohibit MA plans from denying care ordered by a physician based on a particular provider type or setting unless medical necessity criteria are not met.  

    The letter also requested that the CMS finalize the proposals that protect patients from care interruptions, treatment delays, and unanticipated medical costs. These include the proposals that ensure the MA plan’s prior authorization approvals remain valid for the duration of the course of treatment and that MA plans cannot retroactively deny coverage for a lack of medical necessity. The letter concluded by stating that the groups “stand ready to continue our work with federal officials to remove obstacles and burdens that interfere with patient care.”  

    The AAMC also submitted a Feb. 13 letter to the agency in response to the MA and Part D policy and technical changes for the contract year 2024 proposed rule [refer to Washington Highlights, Feb. 17].