As MA Prior Authorization Requests Soar, Are Reform Efforts Falling Short?

As CMS firms up plans to collect more granular information from Medicare Advantage organizations on service coverage denials, a timely analysis from KFF finds that their use of prior authorization (PA) surged to over 46 million requests in 2022. This marks a notable increase from the 37 million requests recorded in 2019, reflecting both the growing enrollment in MA plans and the expanding scope of services requiring prior approval. And while several insurers this year have publicized their efforts to eliminate PA requirements, providers say they’re still feeling the burden, and at least one major MA insurer is adding new PA restrictions.

While PA helps control costs and prevent unnecessary utilization, it can introduce potential barriers to timely care and frustrations for providers. Nearly all MA enrollees (99%) are subject to prior authorization for some services, particularly high-cost ones like inpatient hospital stays, skilled nursing facility stays and chemotherapy.