CMS clarifies prior authorization requirements

As a direct result of AADA advocacy, CMS clarified its prior authorization requirements for Medicare Advantage plans and the Part D Medicare Prescription Drug Benefit, easing the administrative burden on dermatologists and other physicians.

In the final rule, which reflected several recommendations from the AADA, CMS stated that prior authorization requirements for Medicare Advantage plans and Part D Medicare Prescription Drug Benefit will be more consistent with traditional Medicare, providing consistency across federal payer programs.

Policies requiring prior authorization undermine the expertise of physicians and impede patients’ access to the most effective treatments. The policies outlined in this final regulation will take effect on Jan. 1, 2024.