Alliance of Specialty Medicine Cites MA Plan Prior Authorization and Narrow Networks As a Top Regulatory Burden in “Cut the Red Tape” Meeting with HHS

This week, ASCRS, represented by the Alliance of Specialty Medicine, participated in a roundtable discussion with acting Secretary of Health and Human Services Don Wright, MD, MPH; CMS Administrator Seema Verma; and FDA Deputy Commissioner for Policy, Planning, Legislation and Analysis Anna Abram on strategies for cutting regulatory “red tape.” The Alliance noted that specialists are facing a growing burden from Medicare Advantage (MA) plans that are increasingly requiring prior authorizations before proceeding with a course of treatment. In response to our survey, physicians from medical society members of the Alliance have noted a steep rise in prior authorization requests over the last five years. We are urging CMS to require plans to streamline the process with standardized forms and electronic options to reduce the burden on physicians and practices. In addition, we expressed concerns about MA plan narrow networks that potentially exclude specialists and reduce access to care. The Alliance reiterated our previous recommendation that CMS provide additional oversight of the networks to ensure specialists are not excluded. We will keep you updated.