The nation’s largest health insurance company is cutting back its use of prior authorization, a restriction placed on certain medications, tests or health services by insurers that requires doctors to receive coverage approval from payors before providing certain services.
UnitedHealthcare, part of UnitedHealth Group, announced it would remove several services and medications from its prior authorization list starting in the third quarter of this year. In all, the company is eliminating 20% of its current prior authorizations.
“Prior authorizations help ensure member safety and lower the total cost of care, but we understand they can be a pain point for providers and members,” UnitedHealthcare Chief Medical Officer Anne Docimo said in a press release. “We need to continue to make sure the system works better for everyone, and we will continue to evaluate prior authorization codes and look for opportunities to limit or remove them while improving our systems and infrastructure. We hope other health plans will make similar changes.”
The move comes as healthcare officials and lawmakers are taking a hard look at prior authorization and its potential negative impacts on patients. The Centers for Medicare and Medicaid Services (CMS) proposed a new rule at the end of 2022 that would aim to streamline the prior authorization process for clinicians. Prior authorization reform was applauded by more than 100 healthcare groups that banded together last month, urging CMS to make prior authorization easier.
One recent study revealed that physicians almost unilaterally agree prior authorization creates big burdens on their practices and patients. Nearly all––86% of respondents––said PA requirements led to higher overall utilization of healthcare resources, resulting in unnecessary waste rather than cost-savings. Plus, 33% of respondents said prior authorization has led to a serious adverse event for at least one patient.
UnitedHealthcare will also automate and expedite prior authorization in the next few years. In 2024, UnitedHealthcare will implement a national Gold Card Program for care provider groups that meet certain eligibility requirements, which will eliminate prior authorization for most procedures. The code reductions will begin in the third quarter and continue through the rest of the year for most commercial, Medicare Advantage and Medicaid businesses.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."