From lawmakers seeking to halt an upcoming Medicare pilot to BCBS of Alabama and physicians outlining shared commitments, here are six updates on prior authorization that Becker’s has reported since Oct. 8:
1. Six Democratic House representatives introduced legislation to stop the upcoming Medicare prior authorization pilot, the Wasteful and Inappropriate Service Reduction model.
2. Over the next several months, health plans, health systems, policymakers and patients led by Baltimore-based Johns Hopkins will begin addressing prior authorization as part of a convening group.
3. CMS said Cohere Health, Genzeon Corp., Humata Health, Innovaccer, Virtix Health and Zyter will participate as vendors in the Medicare prior authorization pilot.
4. Blue Cross and Blue Shield of Alabama and the Medical Association of the State of Alabama reached an agreed upon changes to prior authorization.
5. The American Hospital Association is urging CMS to delay its Medicare prior authorization pilot — the Wasteful and Inappropriate Service Reduction initiative — by at least six months.
6. California Gov. Gavin Newsom signed a bill into law allowing the state’s Department of Managed Health Care to waive prior authorizations for services or prescriptions that payers approve at least 90% of the time.
