How Is the AAN Advocating to Fix Prior Authorization?

September 6, 2024

One of the AAN’s priority advocacy issues is reducing regulatory burden—the heavy administrative requirements physicians face while providing care for their patients. Regulatory burden can include prior authorization, step therapy requirements, quality reporting, and other administrative tasks.

Here’s a brief guide to prior authorization—and what the AAN is doing to reduce its negative impact on neurology providers and their patients.

What Is Prior Authorization?

While physicians and other health care providers are familiar with prior authorization, people seeking treatment for neurological conditions are often learning of the term for the first time. Prior authorization is a process in which health care providers must get advance approval from their patient’s health plan for a certain service or prescription to be covered.

This process—also called preauthorization or precertification—is used by health plans to control costs, but it can have serious impacts on health care providers and their patients. According to a 2023 survey by the American Medical Association, physicians and their staff spend 12 hours each week on prior authorization, and nearly a quarter of surveyed physicians said the process has led to a serious adverse event for a patient in their care.

Related course: Ask Me Anything About Prior Authorization

Prior authorization has long been an area of concern for AAN members, many of whom have found the process frustrating for themselves and ineffective for their patients. The AAN believes that reducing prior authorization-related burdens will reduce costs and improve patient outcomes by allowing providers to focus more of their time on patient care rather than administrative tasks.

How Is the AAN Advocating to Reform Prior Authorization?

The AAN has a full-time advocacy staff located in Washington, DC, and organizes large events like Neurology on the Hill to make neurologists’ voices heard in the federal government. The Academy also works with members around the country to promote state legislation benefiting neurology professionals and their patients.

On a federal level, the Improving Seniors’ Timely Access to Care Act was introduced this summer in both chambers of Congress. The bill, which would help reduce the administrative burden faced by physicians due to prior authorization requirements in Medicare Advantage plans, has been one of the AAN’s top advocacy priorities since its first introduction.

The AAN worked closely with bill sponsors and other physician organizations to ensure the bill’s reintroduction. The Academy will continue to work to urge Congress to pass the legislation before the end of the year.

Additionally, the Centers for Medicare & Medicaid Services (CMS) finalized two crucial rules in April 2023 and January 2024 reforming how Medicare Advantage, Medicaid, and Exchange plans may implement utilization management policies like prior authorization. The AAN has since responded to a request for information on further reforms to the process and continues to advocate that the agency to extend critical reforms to medications. The AAN also works with regulators to promote the standards and technical infrastructure needed to improve and automate electronic prior authorization.

The AAN has also been advocating for prior authorization reform at the state level. This year, the Academy celebrated wins in Colorado, New Jersey, Oklahoma, and Vermont, streamlining the prior authorization process and reducing barriers faced by patients and their physicians that delay access to treatment.

In Colorado, the legislation included provisions requiring the establishment of an exemptions program to remove the administrative burdens associated with prior authorization for qualified providers. In Vermont, the legislation mandated that health insurance plans using step therapy protocols must not require patients to fail the same medication more than once and must grant exceptions under specific conditions.

How Can Members Get Involved?

Neurology providers interested in advocating for their field can get started by browsing the AAN’s advocacy resources. US members also receive the biweekly Capitol Hill Report, which provides short updates on legislative and regulatory advocacy for neurology, and use the AAN’s Advocacy Action Center to contact their representatives on key issues.