States Get in on the Prior Authorization Crackdown

The Biden administration is cracking down on insurance plans’ prior authorization policies for certain health plans participating in federal programs, such as Medicare Advantage or the Affordable Care Act marketplace. States are also taking action to pass their own restrictions on prior authorization requirements. Doctors and hospitals are supporting these efforts, with some states passing legislation to exempt certain providers from always needing to request authorization for care through a program called “gold carding.” The American Medical Association is tracking active gold carding bills in 13 states, with notable victories in New Jersey and D.C. Patients and doctors are frustrated with prior authorization requirements, with many facing denials for necessary medical treatments.

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