Prior Authorization Updates

ASRS opposes Amerigroup’s Prior Authorization Policy

  • The Alliance for Specialty Medicine (Alliance), of which the ASRS is a member, is building strong congressional support to rein in prior authorization (PA) in Medicare advantage (MA) plans. So far, 103 members of Congress have joined a letter to CMS expressing serious concern about reports from physicians and patients in their districts of onerous and often unnecessary PA requirements that are creating barriers to timely care. In some cases plans are requiring repetitive PA for patients that are not evidence based and in other cases PA requirements are for services being performed in accordance with an already-approved plan of care. (October 2018)

  • Representatives Phil Roe (R-TN) and Ami Bera (D-CA) are circulating a “Dear Colleague” letter to US Representatives at the request of the Alliance and other specialty societies, asking that they join them in a letter to CMS Administrator Seema Verma requesting tighter restrictions on prior authorization (PA) in Medicare Advantage (MA), noting that barriers to timely access to care are often caused by onerous and often unnecessary prior authorization requirements. The Dear Colleague letter was drafted prior to last week’s announcement by CMS encouraging MA plans to use of step therapy for Part B drugs next year, describing step therapy as a “type of prior authorization” which has been and continues to be allowed for Part B drugs. Read Aug. 8 ASRS story. (August 2018)
  • ASRS sent a letter to Amerigroup concerning its prior authorization rule to limit physician choice of Eylea for patients with diabetic macular edema after 5 injections. If burdensome prior authorization polices hinder your ability to provide the best care for your patients, please contact with the name and type of insurance plan and the specific wording of the policy. (Posted 5/30/2018)
  • Last week the ASRS met with Ways and Means Health Subcommittee Chairman Peter Roskam (R-Ill.) for a roundtable discussion with the Alliance of Specialty Medicine, a coalition ASRS joined in February. Roskam, the newly appointed Chairman, has been convening a number of recent roundtable discussions as part of the Medicare Red Tape Relief Project spearheaded by the Ways and Means Committee last year. (April 2018)
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