Final Prior Authorization Rules Look to Streamline the Process, but Issues Remain

(By Kaye Pestaina, Justin Lo, Rayna Wallace, and Michelle Long for The Kaiser Family Foundation Published: May 02, 2024)

As concerns continue to be raised about consumer barriers to care resulting from prior authorization requirements, the federal government issued a final regulation aimed at streamlining and automating the prior authorization process and improving transparency for certain payers. Over the past two years, research and investigations into the use of prior authorization in Medicare Advantage and Medicaid managed care plans have brought renewed attention to the prior authorization process. For private commercial coverage, a growing number of states have passed wide-ranging prior authorization changes. This Issue Brief discusses the final regulation issued by the Centers for Medicare and Medicaid Services (CMS), how it might address some of the current consumer concerns, and the areas that are left for further evaluation. Key takeaways include: Continue reading here…

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