Rep. Mark Inexperienced (R-Tenn.) reintroduced a invoice Thursday looking for to nix prior authorization necessities in Medicare, Medicare Benefit, and Half D prescription drug plans.
The measure is utilized by insurers to approve the price of therapy plans, remedy and or procedures earlier than a prescription or operation may be obtained or carried out.
“We’ve got to let doctors focus on treating patients. True peer-to-peer deliberations will help to reduce stress and frustration in the prior authorization process—and that’s why I’m introducing the Medically Unnecessary Delays in Care Act of 2025,” Inexperienced mentioned in a press release unique to The Hill.
“This bill will smooth the way for Medicare and Medicare Advantage recipients to get the healthcare they need.”
The Lowering Medically Pointless Delays in Care Act of 2025 goals to rid the listed insurance coverage suppliers of such necessities with assist from fellow GOP Reps. John Joyce (Pa.), Wealthy McCormick (Ga.), Andy Harris (Md.), Tim Burchett (Tenn.), and Brian Babin (Texas), who co-sponsored the laws along with Democratic co-lead Kim Schrier (Wash.).
Inexperienced, who has confronted his personal battle with in depth medical remedies, mentioned he is aware of firsthand the stresses of prior authorization.
“As a survivor of both colon and thyroid cancer, I know how critical it is to start treatment as soon as possible. Prior authorization can be a roadblock that costs lives,” mentioned Inexperienced, a former doctor.
“Doctors need to be able to make fast, life-saving decisions without a jungle of red tape to cut through.”
Ninety-four p.c of physicians believed that prior authorization necessities negatively impacted affected person care, whereas 23 p.c of physicians reported that prior authorization has led to a affected person’s hospitalization, in line with a 2024 survey revealed by the American Medical Affiliation.
“The overuse of prior authorization is a persistent obstacle that prevents patients from receiving quality care from their physicians. Often, prior authorization requests are reviewed—and denied—by insurance company representatives who lack the medical expertise to appropriately judge what level of care is necessary for a patient,” Bruce A. Scott, American Medical Affiliation president, mentioned in a press release.
“This welcome legislation would require the reviewers to be physicians with actual experience in the field of medicine they are passing judgment over. Our patients deserve no less.”
Final 12 months, the Biden Administration revealed a closing federal rule requiring Medicare Benefit, Medicaid or the ObamaCare exchanges to reply to expedited prior authorization requests inside 72 hours, and commonplace requests inside seven calendar days.
“No one should lose out on medical care because an AI algorithm is challenging what a doctor has already deemed a necessity. As a physician myself, I’ve seen firsthand how prior authorization has created life-threatening barriers to essential and standard care,” mentioned Schrier, co-chair of the Congressional Docs Caucus.
“I will work alongside any of my colleagues to ensure the best healthcare outcomes for my constituents, and neither they nor their doctors should have to fight insurance companies in their moment of need.”
