The burden of prior authorization (PA) for urologists and their patients is growing as health care reform continues to take shape. As the health care industry shifts to value-based care, insurers are increasingly instituting PA policies to ensure that expensive interventions and treatments are clinically appropriate and cost-effective.

Urologists report that they are spending inordinate time filling out PA forms, which leads to increased costs, decreased access to care, and lower quality of care. Many patients also find PA to be a stressful and disruptive obstacle to accessing their necessary care. According to the American Medical Association’s 2022 physician survey on prior authorization, 56% of survey respondents reported that prior authorization always or often delays patient access to necessary care. In addition, one-third of doctors reported that prior authorization delays led to adverse consequences for their patients.¹ This impact included delays in care, an increase in paperwork, and added workload for urology practice staff. Additionally, 81% reported PA negatively impacting the care of their patients.¹ The lengthy and complex process of obtaining PA adds financial strain to a urology practice and limits access to care for patients.

This has led to efforts to enact policy changes related to the PA process by both Congress and the current Administration. Last year, the House of Representatives passed H.R. 3173, the Improving Seniors’ Timely Access to Care Act, which would require the U.S. Department of Health & Human Services to establish an electronic PA process, including a real-time process for services that are routinely approved. While this legislation did not make it through the Senate, its unanimous passage in the House has shown that there is movement for finding a solution.

Most recently, as the AUA’s Public Policy Council Chair, I advocated for urology at a closed-door meeting at the Department of Health & Human Services in Washington, DC, as part of the Alliance of Specialty Medicine to discuss proposed rules related to PA that the Biden Administration released late last year (see Figure). These proposed changes range from increasing transparency in the approval and denial process to shortening the allowable waiting period for approvals. Other stakeholders in attendance included the American Medical Association, American Hospital Association, and the Medical Group Management Association. Federal officials included U.S. Surgeon General Vivek H. Murthy, MD, CMS (Centers for Medicare and Medicaid Services) Administrator Chiquita Brooks-LaSure, and CMS Office of Burden Reduction & Health Informatics Director Mary Greene, MD.

Advocacy requires playing the long game, actively engaging Congress, the Administration, and the patient advocacy and provider groups, which has led to tremendous strides in finding a solution over the past year.

Moving forward, it’s imperative that the AUA and our urologists continue to support efforts related to reforming the PA process and any regulatory burdens that hinder our ability to provide our patients with the care they need. That is why I ask that you attend the Annual Urology Advocacy Summit every year in our nation’s capital.

It’s clear that concrete legislative reforms are necessary to minimize the burden of PA on patients. As Representative Ami Bera, MD (D-CA-06) puts it, “Administrative burdens for providers should never get in the way of providing the best possible care for patients.”²