AMA Pushes for Openness in Prior Authorization, Citing Payer Profits & Patient Harm
CHICAGO – The American Medical Association (AMA) is intensifying its fight against burdensome prior authorization practices, adopting new policy aimed at exposing the financial incentives driving delays in patient care and physician payments. At its 2025 Interim Meeting, the AMA passed a resolution calling for examination and public disclosure of profits earned by commercial insurers, Medicare Advantage, and Medicaid health plans through the use of prior authorization.
For years, physicians and patients have reported notable obstacles navigating prior authorization requirements – a process where health plans require pre-approval for certain medical services, medications, and procedures.These hurdles often lead to delayed or denied care, increased administrative burdens for physicians, and frustration for patients. The AMA’s new policy stems from growing concerns that these delays aren’t simply administrative inefficiencies, but are deliberately employed to benefit payer bottom lines.
The AMA is advocating for several key changes to address the issue. These include the implementation of timely, non-aggregated public reporting by both private and public plans, detailing the number of services approved, denied, and overturned on appeal, as well as the timeframes for authorization responses and claim payments. The association also plans to collaborate wiht organizations to develop and publish scorecards evaluating plan performance in these areas, providing patients, physicians, and employers with crucial data.
“With Medicare Advantage and commercial health plans possibly financially benefiting from delays in authorizing care and processing claims, increased transparency about the companies’ financial gains can empower patients, physicians, employers and policymakers to demand accountability and reform,” the resolution states.
The AMA is also providing resources to support physicians navigating prior authorization challenges. These include Continuing Medical Education (CME) modules focused on the costs of prior authorization in specific specialties, such as dermatology, and videos illustrating the detrimental impact on patient care. Additionally, toolkits are available to help standardize electronic transactions and streamline administrative processes.
This latest action builds on the AMA’s ongoing efforts to simplify prior authorization, reduce administrative burdens, and ensure patients receive timely access to necessary medical care.
