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Issue Background

Uniform Prior Authorization

Where We Stand

  • Prior authorizations cost the health system $728 million in 2012.
  • Prior authorization requests must use a single form, no more than two pages in length.
  • Forms must available for both access and submission electronically.
  • Requests are deemed approved if no response is received within 48 hours.

The administrative burden imposed by myriad insurers' prior authorization requirements costs the health system close to a billion dollars annually. 

In an effort to contain health care costs, most health insurers require a physician to obtain "prior authorization" before prescribing certain medications and health services. Most medical practices contract with multiple insurance companies, each with its own approval process. What's more, each of those companies frequently utilize a different form for each test, procedure, service or medication requested. This administrative burden distracts from the provision of high quality care and costs health system close to a billion dollars annually, according to peer-reviewed reports.

The CSRO endorses and develops resources to support state rheumatology societies' campaigns that promote greater efficiency and transparency in the prior authorization process.

Legislative Map

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