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How much savings will CMS prior authorization reforms achieve by end of 2024?
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Resolution / Starting Odds
Less than $5 billion • 25%
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CMS financial reports and healthcare economic analyses
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CMS Prior Authorization Reforms to Save $15B Amid High Denials
Aug 30, 2024, 06:00 PM
The process of prior authorization in healthcare, a cost-control measure used by health plans, is under scrutiny for delaying patient access to care. The American Medical Association (AMA) has been advocating for reforms, leading to a new requirement for CMS-regulated health plans to offer electronic prior authorizations integrated within electronic health records (EHRs). This change is expected to reduce physician burdens, cut delays for patients, and save $15 billion. Despite these efforts, challenges remain, as evidenced by Medicare Advantage insurance plans denying 3.4 million, or 7.4%, of 46 million prior authorization requests in 2022. Additionally, IQVIA reports that payers initially reject over 75% of cancer drug prescriptions.
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Significant savings (> $2000 per year) • 33%
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