MSSC poll: Prior authorization not improving

Major health insurance companies pledged last summer to “streamline, simplify and reduce” prior authorization. In May, UnitedHealthcare issued a press release announcing it had reduced PA requirements by 30%.

Has this happened? MSSC surveyed its members last month to see if they had experienced a reduction. Overwhelmingly, the answer was “no.”

Of the 57 responses from MSSC members who complete PAs during a typical week, only 7% said that PA volume or demands had been significantly reduced during the past year, and 1% said it had declined somewhat. Meanwhile, 32% said there had been no change; 23% said it had increased somewhat; and 37% said it had increased significantly.

“We now have two full-time employees whose sole job is to handle prior authorizations,” one MSSC member said. “We still can’t get what we need for our patients most of the time.”
MSSC also asked members the other questions about prior authorization that the American Medical Association asked in a national survey last December. MSSC responses were more criti¬cal than those in the AMA survey.

• 46% of MSSC respondents said the PA process always delayed access to necessary care (13% in AMA survey), and another 44% said it often delayed necessary care (42% AMA).
• 96% of MSSC respondents said the PA process had signifi¬cant or somewhat negative impacts on clinical outcomes (92% AMA).
• 93% of MSSC respondents said they were concerned that health plans’ use of AI would increase PA denial rates (60% AMA).

MSSC opinions on PA

More PA denials are not stating the reason for the denials, leaving me confused on what to do for my patients.”

It has become completely cum¬bersome and negatively affecting patient care and physician-patient relationships.”

On more than one occasion I have had to submit a prior auth for inhal¬ers that are desperately needed. Days later, when the patient returns or calls in because they are worse, I find out they couldn’t get the inhaler because it was denied.”

In general, medication prior auths are much more frequent, increas¬ing even on inexpensive generic medications.”

The insurance industry is practicing medicine without a license.”