Prior authorization (PA) is again the target of a federal bill recently re-introduced by physician legislators aiming to reform the process in Medicare, Medicare Advantage, and Part D prescription drug plans.
The move comes just weeks after a group of Texas Medical Association physicians traveled to Washington, D.C., as part of the American Medical Association’s National Advocacy Conference (NAC), which brought legislators’ attention to Medicare pitfalls like subpar payment and PA that challenge practice viability.
On Mar. 27, Rep. Mark Green, MD (R-Tenn.) filed House Resolution 2433, the Reducing Medically Unnecessary Delays in Care Act of 2025, which for certain Medicare plans aims to “ensure that prior authorization medical decisions under Medicare are determined by physicians,” per the proposed legislation’s title.
Specifically, it calls for the aforementioned Medicare plans to:
- Apply evidence-based standards to PA decisions;
- Apply written clinical criteria consistently in PA reviews;
- Make any current PA requirements and restrictions readily available online;
- Notify health care professionals of any new PA restrictions no less than 60 days before their implementation; and
- Ensure PA determinations are made by a physician in the same specialty as the physician seeking preauthorization.
TMA is analyzing the bill, which expands on a similar measure the association supported last year.
“Prior authorization can be a roadblock that costs lives,” Dr. Green said in his press release. “Doctors need to be able to make fast, life-saving decisions without a jungle of red tape to cut through.”
Four of the physician legislators who met with TMA and AMA physicians at NAC’s Fix Medicare Now event – Rep. Greg Murphy, MD (R-N.C.), Kimberly Schrier, MD (D-Wash.), Mariannette Miller-Meeks, MD (R-Iowa), and John Joyce, MD (R-Pa.) – were same-day co-sponsors of the bill. As of this writing, three Texans in Congress, Rep. Brian Babin, Rep. Ronny Jackson, and Rep. Beth van Duyne, have also signed on as cosponsors.
Representative Murphy is also the author of House Resolution 879, the medicine-supported attempt to reverse the 2025 Medicare physician pay cut and replace it with a modest raise.
“As soon as I bring up prior authorization, [federal lawmakers] want to get that fixed,” said TMA President G. Ray Callas, who attended the D.C. event on behalf of Texas. “And when [they] hear our stories about doing treatments, diagnostics, procedures, and then we don’t get paid for it, or it’s delayed in payment, or it’s just a hassle, they say, ‘No wonder y’all are frustrated,’ and they’re frustrated for us.”
At the state level, TMA also is advocating for comprehensive prior auth reform via several bills before the Texas Legislature.
As Texas Medicine Today reported earlier, AMA’s most recent survey on prior authorization shows the process continues to negatively impact physicians and their patients.
“The overuse of prior authorization is a persistent obstacle that prevents patients from receiving quality care from their physicians,” AMA President Bruce A. Scott, MD, said in an April 4 advocacy update. “Often, prior authorization requests are reviewed – and denied – by insurance company representatives who lack the medical expertise to appropriately judge what level of care is necessary for a patient.
“This welcome legislation would require the reviewers to be physicians with actual experience in the field of medicine they are passing judgment over,” Dr. Scott said of HR 2433. “Our patients deserve no less.”
Learn more about TMA’s federal advocacy and explore the association’s practice help resources for prior authorization assistance.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.