Prior Authorization in Healthcare: Balancing Cost Controls and Patient Access


Virtual Event on Feb. 22: The Health Wonk Shop Explores Prior Authorization in Health Insurance – Is it a Necessary Cost-Control Tool or a Barrier to Needed Care?

The practice of requiring prior authorization for healthcare services is a contentious issue among consumers with health insurance. According to recent data, nearly 1 in 5 individuals with health insurance have experienced delays or denials of care due to this process. Prior authorization is a tool used by insurers to limit unnecessary and ineffective care, ultimately reducing costs. However, concerns have been raised about the potential for unreasonable barriers to patients accessing necessary care and the excessive paperwork burdens placed on doctors and other providers.

In an effort to address these concerns, federal regulators have finalized new rules governing how insurers use prior authorization in several key healthcare programs, including Medicare Advantage, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act’s federal Marketplace plans. Additionally, lawmakers are considering potential broader legislation that could further regulate or eliminate prior authorization requirements altogether.

To gain a deeper understanding of the future of prior authorization requirements in healthcare, a panel of experts will join Larry Levitt, KFF’s executive vice president for health policy, for a 45-minute discussion on Feb 22 at Noon ET. The panelists include Troyen Brennan, MD, Adjunct Professor of Health Policy and Management at Harvard T.H. Chan School of Public Health; Fumiko Chino, MD, Radiation Oncologist at Memorial Sloan Kettering Cancer Center; Anna Schwamlein Howard, Principal of Policy Development at American Cancer Society Cancer Action Network; and Kaye Pestaina, Vice President and Director of the Program on Patient and Consumer Protection at KFF.

KFF’s virtual Health Wonk Shop series provides in-depth policy discussions with experts that go beyond news headlines to provide greater insights into current issues facing the healthcare industry. This event is set to take place on Feb 22

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