What 3 payers have said about their prior authorization cuts

As prior authorizations have come under the regulatory and legislative microscope, several payers have announced cuts to their requirements. 

Among those companies are UnitedHealthcare, Cigna and Blue Cross Blue Shield of Michigan

When announcing their respective cuts, the companies acknowledged the administrative burdens prior authorizations place on providers, but defended the overall process as a necessary one. 

"Prior authorizations help ensure member safety and lower the total cost of care, but we understand they can be a pain point for providers and members," Anne Docimo, MD, chief medical officer of UnitedHealthcare, said in a March 29 news release from the payer announcing it was cutting 20 percent of its existing prior authorization requirements. 

Philip Kaufman, UnitedHealthcare's chief growth officer, told The Wall Street Journal March 29 the company was not "deaf to the complaints out there" about prior authorizations requirements and said they've taken a hard look at themselves and the process. 

Prior authorization burdens have long been a complaint from physicians. Ninety-four percent of physicians surveyed by the American Medical Association said the process has delayed necessary care, and 89 percent said it has had a negative effect on patient outcomes, according to a March 13 report. 

"We've listened attentively to our clinician partners and are deliberately making these changes as a result," Cigna's executive vice president and chief health officer, David Brailer, MD, said in an Aug. 24 news release. "We will continue to hold ourselves accountable for this important work and look forward to building on this momentum in the future."

Cigna said it has removed nearly 25 percent (600 codes) of its medical services from prior authorization requirements — amounting to more than 1,100 medical services since 2020.   

Blue Cross Blue Shield of Michigan is in the process of cutting 20 percent of its prior authorization requirements. James Grant, MD, the payer's senior vice president and chief medical officer said in a Sept. 7 news release that they are focused on partnering with the physician community to ensure beneficiaries get timely care without roadblocks. 

Dr. Grant said that as technology platforms continue to evolve, BCBS Michigan's long-term aim is to let these advances "enable us to move from a world of 'authorization' to 'clinical decision support.'"

"This way, all stakeholders, especially physicians, nurses, their staff and our members, will be able to quickly receive transparent, evidence-based decisions and status updates through their electronic medical record," he said. "This also ensures that coordinated care moves forward safely and without delay."

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