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May 29, 2019

AGA is fighting prior authorization hassles

We need a simpler process that’s less burdensome on our practices.

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AGA is working on your behalf to address prior authorization hassles with private payors. We know private payors continue to implement prior authorization policies, which provide no benefit to patients. Specifically, AGA is collecting stories on Anthem’s policy that requires prior authorization before performing any esophagogastroduodenoscopy (EGD) procedure. This policy has been implemented in several states and we are hearing it is hurting GI's ability to provide care to patients who need it most. Anthem continues to implement more and more draconian programs that overburden our members with unnecessary requirements that provide no value to our patients. We know that’s wrong. Help us send a clear message to Anthem by sharing your experience on the AGA Community.   


We will take your stories directly to Anthem and demand that they work with us, like other payors do. Share your story today and tell your colleagues about this opportunity, so they can participate too.


AGA and the entire physician community have also been calling for regulatory changes related to prior authorization in Medicare Advantage (MA) plans. 


Last year, AGA worked with our congressional champions Reps. Phil Roe, MD, R-TN), and Ami Bera, MD, D-CA, to secure 150 signatures on a letter to the CMS Administrator requesting the agency provide guidance to MA plans to ensure that prior authorization requirements do not create barriers to care. 


One in every three people with Medicare is enrolled in a MA plan. Under current law, MA plans may not create inappropriate barriers to care that do not already exist within the original Medicare program. However, physicians are reporting that MA plans have imposed increasingly onerous prior authorization requirements for medical services and procedures that are impacting patient access to medically necessary care. AGA and other physician organizations are advocating for regulatory changes related to how MA plans use prior authorization.


In addition to our regulatory efforts, AGA has also been working with members of Congress on legislative solutions to require the MA plans to increase transparency, streamline the prior authorization process and minimize the impact on Medicare beneficiaries. Prior authorization is an administrative burden to physicians that impacts our ability to provide timely care to our patients. Stay tuned for legislation that will be introduced to address these administrative burdens.

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