Providers that use certified IT systems would have access to up-to-the-minute price information and streamlined prior authorization requests.
Medicare patients will have access to real-time prescription drug pricing and streamlined prior authorization decisions starting in October, the Department of Health and Human Services (HHS) announced Sept. 2.
That’s enabled by a new regulation that allows doctors with certified information technology systems to obtain up-to-the-minute pricing information.
Providers will also be able to submit prior authorization requests to insurers electronically, reducing the time for a decision and easing a longstanding problem for doctors and patients.
“By improving patient outcomes, cutting provider burden, and ensuring full transparency at the point of care, we are delivering on our promise to Make America Healthy Again,” HHS Secretary Robert F. Kennedy Jr. said in a Sept. 2 statement.
Insurers Cooperate
A coalition of 10 large health insurance companies pledged in June to overhaul the often-criticized prior authorization process for more than 250 million Americans enrolled in commercial, Medicare Advantage, and Medicaid managed care plans.
Kennedy thanked insurance companies for their commitment, and the Trump administration was “actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.”
Physicians handle about 40 preauthorization issues and requests each week, taking about 12 hours on the paperwork, according to Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services.
Technology Driven
Part of the problem was the lack of a standardized system for submitting prior authorizations.
“The healthcare system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike,” Mike Tuffin, president and CEO of trade association America’s Health Insurance Plans, said in a June statement praising the industry’s effort to streamline the process.
The finalization of a federal certification for health information systems will enable Medicare providers to obtain prior authorizations electronically.
Achieving that was an important step toward reducing the paperwork burden on health providers and facilitating patients’ access to care, according to the Assistant Secretary for Technology Policy and National Coordinator for Health Information Technology, Dr. Tom Keane.
