Bipartisan legislation announced on June 5 would protect patients from unreasonable prior authorization requirements that delay or deny access to care. The Regulatory Relief Coalition – a coalition of eight national medical societies, including the ACC – is supporting the bill.

The Improving Seniors' Timely Access to Care Act of 2019, sponsored by Reps. Suzan Delbene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD, (R-KS), and Ami Bera, MD, (D-CA), would improve the current prior authorization system by requiring the Centers for Medicare and Medicaid Services (CMS) to regulate Medicare Advantage plans on the use of prior authorization. The legislation would also bring greater transparency to the prior authorization process by requiring Medicare Advantage plans to report to CMS on the extent of their use of prior authorization and the rate of approvals or denials by service and/or prescription medication.

In conjunction with the bill's introduction, the Regulatory Relief Coalition released results of a physician survey that details the extent to which prior authorization policies are putting patients at risk and increasing burdens on physician practices. Among the findings, an overwhelming number of physicians (87 percent) report that prior authorization has a significant or somewhat negative impact on patients' clinical outcomes, with consequences ranging from patients abandoning their treatments to being asked to switch medications without medical reasons to do so.

"Prior authorization requirements pose a significant challenge to ensuring the right treatment for the right patient at the right time," said ACC President Richard J. Kovacs, MD, FACC. "Over the last several years the ACC has been working with stakeholders across the health care environment to find solutions that improve patient care and reduce administrative burden on the clinicians who serve them. The bipartisan prior authorization legislation announced today is an important step in making sure that patient care comes first."

Reducing administrative burden, including unnecessary prior authorization requirements, is a strategic priority for the ACC. In addition to being part of the Regulatory Relief Coalition, the College has developed a set of principles to guide its advocacy and policy actions; implemented prior authorization reporting tools to help its members track the number of prior authorization requests for medical imaging and PCSK9 drugs; and most recently announced a new initiative that leverages prospective clinical registry data from the PINNACLE Registry. Partnerships spanning the pharmaceutical and medical device industry, health plans, employers, clinicians and patients aim to change this paradigm and reduce the administrative burden associated with ensuring the most vulnerable heart disease patients have access to medications that can save their lives.

Keywords: ACC Advocacy, Medicare Part C, Centers for Medicare and Medicaid Services, U.S., Proprotein Convertases, Medicaid, Registries, Diagnostic Imaging, Heart Diseases

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