The news: Around 50 health plans—including large players UnitedHealthcare, CVS Health, Cigna, and Elevance Health—are pledging to simplify the prior authorization process.
One agreement is that 80% of electronic prior authorization approvals with all necessary clinical documentation will be answered in real-time. They’ve also agreed to reduce the types of claims that necessitate a prior authorization, though this goal doesn’t come with a specific metric to reach. The commitment is voluntary for the time being.
Zooming in on prior authorization: It’s a way for insurers to determine whether they’ll pay for a prescribed medication or service. For treatments or procedures that require prior authorization, doctors must obtain advance approval from the patient’s insurance company. Health plans attest that this process ensures that patients receive care and treatment that’s medically necessary while allowing them to manage costs.
Yes, but: Prior authorizations create administrative burdens for doctors, and delay or deny care for patients.