When the Congressional Budget Office re-scored the Seniors’ Timely Access to Care Act last February, the $10 billion price tag might have been a fatal blow to efforts to address the use of prior authorization in the Medicare Advantage (MA) program. At the time, I weighed in with Inside Health Policy on behalf of the Cancer Support Community saying, “while I hope this new score reflects CBO’s continued misunderstanding of the rules governing MA plans and their reluctance to change that perspective until the rules are finalized, I’m afraid this just confirms what we already knew: MA plans use prior authorization to deny patients appropriate and desperately needed care.”
Unfortunately, with a score that high, we were left to wait for the Biden Administration to finalize rules clarifying and modernizing prior authorization practices. While the new regulations represent a win for advocates on their own, many hoped that capturing some of this policy in administrative practice would bring down the cost of the bill as well.
Last month, the Biden Administration did FINALLY finalize its prior auth rules and last week, I had the opportunity to sit down with Peggy Tighe, Principal at Powers law and the brain, chief strategist, and advocacy might behind the Seniors’ Timely Access to Care Act and the massive Regulatory Relief Coalition. I asked Peggy to share her thoughts and insights about what’s next for prior auth and to learn more about what we can all do to help.
