A new Biden administration rule released Wednesday aims to streamline the prior authorization process used by insurers to approve medical procedures and treatments. Prior authorization is a common tool used by insurers but much maligned by providers and patients, who say it’s often used to deny provider-recommended care.

ONS Perspective

An often complex and lengthy process, prior authorization can be an obstacle to necessary patient care. The Biden-Harris administration’s new rule is intended to increase access to care by requiring health insurers participating in Medicare Advantage, Medicaid, or the Obamacare exchanges to respond to expedited prior authorization requests within 72 hours and standard requests within seven calendar days. The increased efficiency could save healthcare institutions and practices more than $15 billion in 10 years.

Although it’s a win for part of the U.S. population, “the new rules don’t apply to veterans who receive their care through the Department of Veterans Affairs or the estimated 153 million Americans covered by private, employer-sponsored plans,” The Hill reported. 

Oncology nurses can advocate for expanding the rule to more Americans by sharing their patients’ stories with their legislators. Learn how you can reach out to the policymakers who represent you and your patients, at home and on Capitol Hill.

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