• Family Physicians Applaud Proposed Rules from CMS to Streamline Prior Authorization, Avert Care Delays 

    March 14, 2023

    Statement attributable to:
    Tochi Iroku-Malize, MD, FAAFP
    American Academy of Family Physicians

    “The American Academy of Family physicians (AAFP) supports two recent proposed rules from the Centers for Medicare and Medicaid Services (CMS) that mark a significant step toward addressing the harms caused by prior authorizations. If finalized, these rules would bring much needed administrative simplification for physicians while reducing care delays for patients.

    “Every day, family physicians experience firsthand how prior authorizations divert valuable resources from direct patient care and can lead to negative patient outcomes, including forgoing care. To that end, the AAFP is pleased to see a proposed rule by CMS that would leverage the latest technology to help automate and streamline prior authorization processes and make it easier to access health information. The AAFP applauds CMS for advancing the automation of prior authorization and strongly urges the agency to finalize these proposals, along with others aimed at improving prior authorization transparency and ensuring a timely response from payers. 

    “While automation is a crucial step toward reducing care delays and administrative complexity, the AAFP has repeatedly called for more comprehensive federal action to address the overwhelming volume of prior authorization requirements. As such, we are encouraged by another recent CMS proposal to address inappropriate denials of prior authorization in Medicare Advantage and to require Medicare Advantage organizations to adopt evidence-based, publicly accessible coverage policies. The AAFP is hopeful these policies will advance timely, equitable access to care for beneficiaries and urged CMS to apply the same principles to Medicare Part D prescription drug coverage.

    “Taken together, these two proposals will enable family physicians to spend more time caring for their patients. However, we need concrete Congressional action to move the needle forward. Along with our support for the provisions in this proposed rule, we continue to urge Congress to reintroduce and pass the Improving Seniors’ Timely Access to Care Act, which would codify some of these policies into law and protect Medicare Advantage patients from unnecessary delays in care and protect Medicare Advantage patients from unnecessary delays in care for years to come.” 

    Editor's Note: To arrange an interview with Dr. Iroku-Malize, contact Julie Hirschhorn, 202-655-4949, or jhirschhorn@aafp.org.



    About American Academy of Family Physicians
    Founded in 1947, the AAFP represents 130,000 physicians and medical students nationwide. It is the largest medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits — that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care. To learn more about the specialty of family medicine and the AAFP's positions on issues and clinical care, visit www.aafp.org. For information about health care, health conditions and wellness, please visit the AAFP’s consumer website, www.familydoctor.org.