How 10 States are Reforming Prior Authorization in 2024

In 2024, ten states took substantial steps to reform prior authorization (PA) processes to reduce patient care delays and cut down administrative burdens on healthcare providers. These reforms, supported by state medical societies and the AMA, focus on increasing transparency, expediting response times, and reducing the number of procedures and medications that require prior authorization.

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Key Reforms Include:

1. Extending Prior Authorization Validity: States like Vermont and Minnesota have enacted laws to ensure that prior authorizations for chronic conditions remain valid for the duration of the prescription, minimizing the need for repeated reauthorization and reducing disruptions in care.

2. Faster Response Times: In states such as Vermont and Wyoming, insurers must respond to urgent prior authorization requests within 24 to 72 hours and to non-urgent requests within five days, ensuring timely access to necessary care.

3. “Gold Card” Programs: Wyoming has introduced a program that exempts physicians from prior authorization requirements if they have a history of consistent approvals for certain procedures or medications, helping to streamline processes for high-performing providers.

4. Data Transparency and Reporting: Several states, including Colorado, Illinois, and Maryland, now require insurers to publicly report the frequency and outcomes of their prior authorization decisions. This increased transparency helps hold insurers accountable and ensures the process is more predictable for healthcare providers.

5. Preserving Existing Authorizations: Massachusetts is considering legislation that would require new insurers to honor prior authorizations from a patient’s previous health plan for at least 90 days after enrollment, helping maintain continuity of care during transitions between plans.

6. Additional Reforms: Other states, such as Mississippi, Maine, Oklahoma, and Virginia, have also enacted various measures to simplify the prior authorization process. These reforms include reducing the number of services requiring prior authorization, expanding exemptions for specific treatments, and ensuring that prior authorizations for chronic disease management remain valid for extended periods.

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These state-level reforms represent a growing movement to reduce administrative burdens, improve patient access to care, and foster a more transparent and efficient healthcare system. As more states join the effort, there is hope for a broader national standard for reforming prior authorization practices.

For further details, read the full article on the AMA website here.