Reforming Prior Authorization in Medicare Advantage: AMA's Advocacy in Focus

The American Medical Association (AMA) supports the Improving Seniors’ Timely Access to Care Act, bipartisan legislation aimed at reforming prior authorization practices in Medicare Advantage, which the organization describes as a persistent barrier to timely, medically necessary care for older adults.

The bill seeks to simplify and accelerate prior authorization decisions and improve transparency by requiring Medicare Advantage plans to base authorization requirements on evidence-based clinical criteria and to review those requirements annually. It would also require plans to implement electronic prior authorization programs that follow newly developed federal standards and report authorization use, approval rates, and denials to the Centers for Medicare & Medicaid Services (CMS).

The legislation aligns with CMS’ 2024 Interoperability and Prior Authorization final rule and clarifies CMS’ authority to establish approval timeframes, including expedited pathways for emergent services.

The AMA argues that current prior authorization practices lead to significant care delays, patient harm, and administrative burden. In an AMA-led sign-on letter supported by more than 120 medical specialty societies and state medical associations, the organization cites survey data showing that prior authorization is frequently associated with delayed treatment, abandonment of recommended care, and adverse patient outcomes. The AMA emphasizes that Medicare Advantage beneficiaries experience delays and denials that would not occur under traditional Medicare, underscoring the need for legislative reform.

The Improving Seniors’ Timely Access to Care Act has extensive bipartisan backing, with more than half of U.S. House members and a supermajority of U.S. Senators serving as co-sponsors. The AMA and supporting organizations are urging congressional leadership to bring the legislation to the floor and pass it, describing reform of prior authorization as an urgent policy priority to reduce barriers to timely, clinically appropriate care.