Rep. Mark Green (R-Tenn.) reintroduced a bill Thursday seeking to reform prior authorization requirements in Medicare, Medicare Advantage, and Part D prescription drug plans requiring only specialty board certified physicians to make important decisions about treatment.
The prior authorization measure is used by insurers to approve the cost of treatment plans, medication and or procedures before a prescription or operation can be obtained or performed.
“We’ve got to let doctors focus on treating patients. True peer-to-peer deliberations will help to reduce stress and frustration in the prior authorization process—and that’s why I’m introducing the Medically Unnecessary Delays in Care Act of 2025,” Green said in a statement exclusive to The Hill.
“This bill will smooth the way for Medicare and Medicare Advantage recipients to get the healthcare they need.”
The Reducing Medically Unnecessary Delays in Care Act of 2025 aims to rid listed insurance providers of such requirements and has support from fellow GOP Reps. John Joyce (Pa.), Rich McCormick (Ga.), Andy Harris (Md.), Tim Burchett (Tenn.), Greg Murphy (N.C.) and Brian Babin (Texas), who co-sponsored the legislation in addition to Democratic co-lead Kim Schrier (Wash.).
Green, who has faced his own battle with extensive medical treatments, said he knows firsthand the stresses of prior authorization.
“As a survivor of both colon and thyroid cancer, I know how critical it is to start treatment as soon as possible. Prior authorization can be a roadblock that costs lives,” said Green, a former physician.
“Doctors need to be able to make fast, life-saving decisions without a jungle of red tape to cut through.”
Ninety-four percent of physicians surveyed said they believed prior authorization requirements negatively impacted patient care, while 23 percent of physicians reported that prior authorization has led to a patient’s hospitalization, according to a 2024 survey published by the American Medical Association.
“The overuse of prior authorization is a persistent obstacle that prevents patients from receiving quality care from their physicians. 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,” Bruce A. Scott, American Medical Association president, said in a statement.
“This welcome legislation would require the reviewers to be physicians with actual experience in the field of medicine they are passing judgment over. Our patients deserve no less.”
Last year, the Biden Administration published a final federal rule requiring Medicare Advantage, Medicaid or the ObamaCare exchanges to respond to expedited prior authorization requests within 72 hours and standard requests within seven calendar days.
“No one should lose out on medical care because an AI algorithm is challenging what a doctor has already deemed a necessity. As a physician myself, I’ve seen firsthand how prior authorization has created life-threatening barriers to essential and standard care,” said Schrier, co-chair of the Congressional Doctors Caucus.
“I will work alongside any of my colleagues to ensure the best healthcare outcomes for my constituents, and neither they nor their doctors should have to fight insurance companies in their moment of need.”
Updated at 7:14 EDT.
