CMS to alter prior authorization process this year, Verma says
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February 11, 2020 11:36 AM

CMS to alter prior authorization process this year, Verma says

Maria Castellucci
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    CMS Administrator Seema Verma

    The CMS will be making changes sometime this year to prior authorization regulations, according to CMS Administrator Seema Verma during a speech at the American Medical Association's National Advocacy Conference in Washington D.C.

    Verma offered few details on what the changes will be, only mentioning that automation of the process can improve efficiencies. A CMS spokesman said the agency didn't have any additional details to provide at this time.

    Prior authorization has been of interest to the CMS with the agency hosting 35 listening sessions and analyzing more than 2,000 comments it received from a request for information as part of its Patients over Paperwork initiative.

    "The Trump administration is once again ready to take action to support doctors and patients and we will reduce administrative waste, increase patient safety and free physicians to spend time caring for their patients," Verma said during the speech.

    Prior authorization, the process required by insurers and pharmacy benefit managers to approve certain drugs and procedures before they can be administered, has been a point of contention for physicians and patients.

    Doctors argue the process delays patient care and wastes time they could be spending with patients. The AMA has taken up the issue with advocacy efforts and research.

    Verma's mention of automation as a solution to prior authorization is in line with efforts already ongoing in the industry.

    During her speech, Verma also highlighted ongoing policy initiatives by the CMS including increasing the index for low-wage hospitals, decreasing the number of quality measures in its programs and possibly significant changes to Medicaid.

    Verma specifically mentioned the recently announced Healthy Adult Opportunity initiative, which allows states to offer Medicaid coverage to adults that don't otherwise qualify in exchange for capped funding.

    The initiative, which was announced in late January, immediately garnered backlash with some concerned it will put coverage access to Medicaid at risk.

    Verma addressed those concerns, saying the Healthy Adult Opportunity initiative doesn't cut Medicaid funding but rather it continues federal dollars based on historical spending with a "reasonable growth rate."

    "Only in Washington can capping the rate of spending growth be frantically decried as a cut," she added.

    Verma also continued to oppose Medicare for All and public option rhetoric, which she has done in other public remarks.

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