Prior authorization: The wrong choice for Medicare plans

Like millions of doctors, I knew the best care and treatment to prescribe for my patients. As a former ER physician, I built trust with my patients and was there for them when they received bad news. As a patient myself, I remember when my physician told me I had colon cancer, one of the deadliest forms of cancer in the United States. When it comes to cancer, early detection saves lives, but prior authorization is a roadblock on the path to detection and treatment.

Doctors must be able to provide the best treatments possible, but practices like prior authorization tie their hands while they wait for a bureaucratic review. This leaves patients wondering if they will even be approved for life-saving treatment.

Prior authorization is one of the worst medical practices. Physicians are the best determiners of what care their patients need. Giving insurance companies the power to override the medical judgment of doctors is wrong. These administrative roadblocks cost Americans their health and their lives. That’s why I re-introduced the Reducing Medically Unnecessary Delays in Care Actin the 118th Congress. My bill addresses prior authorization in Medicare, Medicare Advantage, and prescription drug care plans in Medicare. Under my bill, restrictions must be based on medical necessity and written clinical criteria. This also applies to prescription drug care. Ultimately, my bill requires that board-certified physicians in the relevant specialty have the final say on the health of their patients.

No bureaucrat should have the power to unilaterally deny care to patients or veto a doctor’s prescribed treatment. Nor should doctors be forced to become administrators or paper pushers. Right now, doctors spend the equivalent of two business days a week filling out prior authorization requests. Patients and physicians alike share in this frustration. Delaying care, or worse, denying care prescribed by a doctor, leads to worse outcomes for patients — sometimes with deadly consequences. 

Doctors and their patients should be the ones making vital health care decisions, not accountants concerned about the bottom line. We need streamlined care, not more red tape. Prior authorization does more harm than good. It’s time for Congress to act. Let’s step up and put the health and well-being of patients ahead of bureaucracy.

Mark Green is a physician and combat veteran of Afghanistan and Iraq, where he served three tours. He interviewed Saddam Hussein for six hours on the night of his capture. He is chair of the House Homeland Security Committee and serves on the House Armed Services and Foreign Affairs Committees.

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