Payers’ prior authorization denial rates go public: 5 notes For the first time, payers must publicly post data on how often they deny prior authorization requests, how quickly they process them and how often denials are overturned on appeal. The first reports are due March 31 under a rule CMS finalized in 2024.

Payers must publish aggregated #PriorAuthorization metrics on their public websites annually. The first set is due March 31.

New trick from PBM: lookin' at you Blue Cross
Pt needs 60 tablets for 30 days of a medication that has been one copay for more than 5 years. Insurance will only approve 30 tabs every 15 days so BCBS gets two copays now.
The med was never denied so there is no pathway to appeal.

#priorauthorization

MACPAC’s March 2026 report to Congress included discussion of automation in Medicaid’s prior authorization process, exploring technology use and policy implications.
https://ow.ly/GHsZ50YtLLq

#Medicaid #PriorAuthorization #HealthPolicy #AIinHealthcare

Two people are engaged in conversation, sitting inside a room. One person is seen from behind, wearing a white coat, listening attentively. The other person is gesturing with their hands while speaking.

Our latest #research polling reveals the challenges patients face with #PriorAuthorization. Most Americans with a #ChronicIllness needed #PriorAuth in the past year, with 41% requiring it multiple times.

Dive deeper into our findings: https://bit.ly/409XSKM

#MedSky #ChronicIllness

𝐌𝐚𝐣𝐨𝐫 𝐩𝐫𝐨𝐠𝐫𝐞𝐬𝐬 𝐟𝐨𝐫 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐚𝐧𝐝 𝐩𝐡𝐲𝐬𝐢𝐜𝐢𝐚𝐧𝐬 𝐢𝐧 𝐖𝐚𝐬𝐡𝐢𝐧𝐠𝐭𝐨𝐧.
Prior authorization reform 𝐄𝟐𝐒𝐒𝐁 𝟓𝟑𝟗𝟓 has passed the Legislature and is now headed to the Governor. This legislation originated with KCMS physicians.
#PriorAuthorization #PriorAuthReform #HealthcarePolicy #PatientAccess

KFF: Medicare Advantage insurers processed 53M prior authorization requests in 2024, with 7.7% denied. Of appeals, 80% were overturned — highlighting ongoing barriers to care.

Full analysis →
https://ow.ly/Unkv50YoR2k

#MedicareAdvantage #PriorAuthorization #PatientAccess #HealthPolicy #KFF

Poll: People View Prior Authorization as Greatest Burden in Navigating the Health System | KFF New KFF polling explores the challenges beyond costs that people with insurance face in navigating the health care system. People cite prior authorization review as their top problem by a wide margin, with a third (32%) saying prior authorization requirements are a “major burden.

🚨 KFF poll: Prior authorization tops the list of burdens for insured adults navigating health care — 4 in 10 with chronic conditions cite it as their biggest challenge.

Full report:
https://ow.ly/re4h50YoQXC

#HealthCare #PriorAuthorization #PatientExperience #KFF #HealthPolicy

Modern Advancements in Radiation Oncology: What Every Oncologist Should Know | JCO Oncology Practice Radiation oncology has undergone a profound transformation over the past 50 years, evolving from broad techniques to highly conformal, precision-guided treatments. This review synthesizes key advancem...

This new JCO OP @ascocancer.bsky.social #radonc review for the general oncologist highlights 🗝️ advancements including cutting-edge tx, the evolving paradigm of met disease, & the integration of immunotherapy w/ #radiation. It also explores the critical concerns of access & #priorauthorization.

Important story from KFF Health News (great nonprofit source to follow): how to track your prior authorization, to help you keep receiving an essential medication. #priorauthorization #pharmsky

Prior Authorizations a "Major Burden" youtube.com/shorts/ybyQY... #youtubeshorts #priorauthorization #poll #healthcare #healthcarecosts

@danlieber.bsky.social thanks for sharing your story. We received a prior auth denial letter the day after surgery. And I’m an educated healthcare expert.
Now I ask each time, is the prior auth approved? I also ask for confirmation in writing.
Read on…
#health #healthcare #payer #priorauthorization

This morning I’m braving the elements to head to Oakland to discuss the future of #priorauthorization. Hear more:

This Scottish lady is me every time I need to contact the:
Pharmacy
insurance
Doctors Office

EVERY FUCKING TIME.
#Diabetes #PriorAuthorization
youtube.com/shorts/fIkIL...

Prescription delays often happen due to prior authorization, where insurers require extra paperwork before covering certain meds. Approvals can take days, may need yearly renewal, and are used to control costs—often frustrating patients. #PriorAuthorization #Pharmacy #HealthInsurance #Healthcare

Rural physician tells committee prior authorizations delay care and impose steep administrative costs Dr. Will Everett, a family physician at Grace Cottage, told a legislative committee that prior authorizations for imaging and procedures often delay needed care, create financial and logistical burdens for patients, and require dedicated administrative staff; he urged revising H.585’s language so hospital‑based primary care practices aren’t excluded from relief.

Dr. Will Everett reveals how prior authorization practices are not only delaying crucial medical care but also imposing significant costs on healthcare providers and patients alike.

Click to read more!

#VT #HealthcareAccess #PriorAuthorization #CitizenPortal #AdministrativeBurden

Massachusetts governor pitches prior authorization reforms: 5 notes - Becker's Payer Issues | Payer News Massachusetts Gov. Maura Healey is the latest state leader to push for prior authorization reform, fleshing out her plan in a Jan. 14 news release. Just one day prior, New York Gov. Kathy Hochul had…

Yesterday #NewYork, today #Massachusetts, although the latter is focusing on #PriorAuthorization reform.

New York governor takes aim at prior authorization: 5 notes - Becker's Payer Issues | Payer News Democratic Gov. Kathy Hochul proposed several initiatives Jan. 13 that aim to shore up healthcare in New York state. Affordability has been a pressing concern among New Yorkers. In the news release,…

“These reforms will improve access to care by removing unnecessary administrative burdens on providers and making sure critical care is neither delayed nor denied,” said a release from #NewYork Governor Hochul's office. #PriorAuthorization

𝐓𝐨𝐨𝐥𝐤𝐢𝐭𝐬 𝐅𝐨𝐫 𝐏𝐡𝐲𝐬𝐢𝐜𝐢𝐚𝐧𝐬
This week, we’re spotlighting the practical tools KCMS has developed to support cervical cancer care. Clinicians and care teams can access the toolkits here:
👉https://ow.ly/ci2o50XApYp

Please share with colleagues!
#CervicalCancerAwareness #PriorAuthorization #KCMS

BILL NUMBER: A9407 PURPOSE OR GENERAL IDEA OF BILL: To prohibit prior authorization for oncology care which has previously been authorized and complies with National Comprehensive Cancer Network (NCCN) guidelines with Categories of Evidence and Consensus 1 or 2A as evidence-based standards of care.

Proud of the New York State Assembly for introducing this bill which bans #priorAuth for any cancer rx w/ a NCCN level 1 or 2A rec. This would be a meaningful step to #FixPriorAuth. 💊 ☢️

#PriorAuthorization: "it's just wasting people's time"

nyassembly.gov/leg/?default...
@ascocancer.bsky.social

I'm not built to do pure #clinical practice in US health care system. I just don't have the patience to deal with #priorauthorization #ICD #insurance companies, and hence I don't bring in big bucks
I just wanna see patients man

WISeR (Wasteful and Inappropriate Service Reduction) Model | CMS Wasteful and Inappropriate Service Reduction (WISeR) Model webpage

Traditional Medicare will now be disadvantaged by the introduction of experimental artificial intelligence #PriorAuthorization strictures courtesy Trump, Dr. Oz, at et als.

Ai #DeathPanel
#AIdeathpanel
#PreAuthorization
www.cms.gov/priorities/i...

Happening THIS WEDNESDAY!

#AIHealth #WhenLawEthicsAndMedicineCollide #AI #HealthInsurance #PriorAuthorization #AIHealthcare #AIHealthInsurance @ai.nejm.org @umnlawschool.bsky.social @iumaurerlaw.bsky.social @harvardmed.bsky.social @danielschwarcz.bsky.social @jennoliva.bsky.social

📣 𝐖𝐫𝐚𝐩𝐩𝐢𝐧𝐠 𝐔𝐩 𝐭𝐡𝐞 𝐂𝐞𝐫𝐯𝐢𝐜𝐚𝐥 𝐂𝐚𝐧𝐜𝐞𝐫 𝐄𝐝𝐮𝐜𝐚𝐭𝐢𝐨𝐧 𝐈𝐧𝐢𝐭𝐢𝐚𝐭𝐢𝐯𝐞
We invite you to visit the KCMS YouTube channel https://ow.ly/Bcog50XAj9f
#CervicalCancer #OncologyEducation #MedEd #HealthcareAccess #PriorAuthorization

Aetna merges prescriptions, procedures into single prior authorization - Becker's Payer Issues | Payer News Aetna is bundling pharmacy prescriptions and medical procedures into a single clinical review, according to a Dec. 4 news release. Providers previously had to submit two prior authorizations, but, as…

Providers previously had to submit two #PriorAuthorization requests, but, as of November, providers only have to file one medical review, and the associated medications are automatically approved. #Aetna

UnitedHealthcare drops prior authorization requirement for 231 procedures Plans could still use strategies other than prior authorization reviews to cut down on unnecessary use of care.

The move affects 196 nuclear medicine procedures, 18 obstetrical ultrasound procedures and 17 electrocardiography procedures. #PriorAuthorization #UnitedHealthcare

#AI #HealthInsurance #PriorAuthorization #AIHealth #AIHealthcare #AIHealthInsurance #InsuranceDenial #PriorAuth

two men are sitting at a table with the words excellent strategy sir written on the screen ALT: two men are sitting at a table with the words excellent strategy sir written on the screen

I read the article and couple of good ideas in here ( #priorauthorization reform, exposure to #rural sites in training), but the fact every single one of the #doctors featured here are white and the word #immigration is not mentioned once in this long article
People who look like me not welcome?

#PriorAuthorization #HealthPolicyExplained #PolicyIsPersonal #HealthcareDelays #PremedTips #AHealthierDemocracy #ThisTermIn60Sec

Drug Channels

via Adam J. Fein Ph.D. - The Hidden Burdens of Cancer Care: When Insurers Override Doctors www.drugchannels.net/2025/11/the-hidden-burde... #Cancer #CancerCare #PriorAuthorization #StepTherapy #FailFirst

#healthcareinnovation #priorauthorization #cmscompliance #aiinhealthcare #payertech #webinar | Paul Cochrane Webinar: Get Ahead of the CMS 2026 Deadline From Fax to Fast: Transforming Prior Authorization Intake With Intelligent Document Processing Tuesday, December 2 | 2 p.m. ET / 11 a.m. PT New CMS rule...

Webinar: Get Ahead of the CMS 2026 Deadline.
Learn how AI can transform prior authorization intake and help you stay compliant before Jan 1, 2026.
Dec 2 | 2 p.m. ET

🔗 bit.ly/47QifBj

#HealthcareInnovation #PriorAuthorization #CMSCompliance #AIinHealthcare #PayerTech #Webinar