GAFP Joins AAFP to Support Proposed Prior Authorization Rules to Lessen Administrative Burden

Recently, the federal government proposed several changes that would force health plans, including Medicaid, Medicare Advantage, and federal Affordable Care Act marketplace plans, to speed up prior authorization decisions and provide more information about the reasons for denials.

Starting in 2026, it would require plans to respond to a standard prior authorization request within seven days, typically instead of the current 14, and within 72 hours for urgent requests. The proposed rule was scheduled to be open for public comment through mid-March.  The Georgia Academy joined the AAFP with a response encouraging these regulations to be finalized, and to also go further to ease prior authorization.

Part of the GAFP comments included the following:

The Georgia Academy strongly supports the Centers for Medicare & Medicaid Services’ (CMS) efforts to improve the electronic exchange of health care data and streamline prior authorization processes. These processes cause barriers to accessing care, delay care for enrollees, and impose significant administrative burdens on physicians.

We must emphasize that the Georgia Academy is deeply disappointed that none of these proposals apply to prior authorizations for prescription and outpatient drugs. Family physicians report that prior authorization requirements for medications are the most burdensome and excluding medications from these requirements will severely limit the impact that this rule will have on improving patient care or reducing administrative burdens.

We strongly urge CMS to expand the proposals in this rule to Medicare Part D plans and prescription drug coverage across other impacted payers.

The Georgia Academy encourages CMS to expand upon this proposal to require plans to implement an electronic prior authorization program that facilitates real-time prior authorization decisions for items and services that are routinely approved, once the relevant standards are mature and have performed successfully in real-world testing.

CMS proposes to require payers to include a specific reason when they deny a prior authorization request.

AAFP and the Georgia Academy continue to seek ways to assist our members with administrative burden which includes onerous prior authorization processes.