The nation’s largest insurers and insurance industry groups agreed to address problems caused by prior authorization, though Health and Human Services Department officials who announced the handshake deal on Monday acknowledged they may need to take additional regulatory action.
Health plans often require additional documentation before agreeing to cover some costly medications or treatments. Both the right and left have criticized its excessive use in denying or delaying needed treatment. Providers also say the practice limits their ability to decide what is best for their patients.
Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services Administrator Mehmet Oz said the insurer agreement came together after a roundtable with HHS and would apply to Medicare Advantage, Medicaid Managed Care, the Health Insurance Marketplace and commercial health plans.
