A new report by the Kaiser Family Foundation (KFF) shows that over 2 million Medicare Advantage (MA) prior authorization (PA) requests were denied in 2021, and that only just over 11% of the denials were appealed. Of the denials that were appealed, 82% of the cases resulted in an overturn of the denial. The number of PA requests and denials ranged across the MA insurers and data is limited due to gaps in what CMS requires MA plans to report.

Why it Matters: The report concluded that “medical care that was ordered by a health care provider and ultimately deemed necessary was potentially delayed because of the additional step of appealing the initial prior authorization decision, which may have negative effects on beneficiaries’ health.”

What’s Next: CMS published two proposed rules in December 2022 to address electronic prior authorization processes and clarify the criteria used by MA plans to establish prior authorization policies. ASTRO will submit comments on both proposed rules in support of the effort to streamline the PA process and to increase transparency and timeliness of PA decisions. Read the full report from KFF.