Advocacy & Practice Updates — Clinical Updates
ASRS Calls on CMS to Include Part B Drugs in Prior Authorization Proposals
This week, ASRS submitted comments to CMS on a proposed rule that seeks to streamline the prior authorization process for Medicare Advantage (MA) and other private payers, by proposing electronic standards for information exchange. While ASRS thanked CMS for listening to our years-long advocacy that MA prior authorization policies create unacceptable delays in necessary care and are a considerable burden on retina practices, we expressed confusion as to why CMS is not proposing to require payers use these standards for any drug authorizations, including physician-administered Part B drugs which are billed through the same claims as other items and services. We urged CMS to extend their proposals to drugs and to implement penalties for payers who do not respond to authorization requests within the timeframes set by CMS.
This proposed rule is a companion to another proposed rule that sought to tighten regulations ensuring that MA plans cover the same items and services as original Medicare and not implement criteria for determining medical necessity that is more stringent than original Medicare.
Posted March 8, 2023