Ama Policy

Abuse of Preauthorization Procedures H-320.945

U.R. Criteria

Our AMA opposes the abuse of preauthorization by advocating the following positions:

(1) Preauthorization should not be required where the medication or procedure prescribed is customary and properly indicated, or is a treatment for the clinical indication, as supported by peer-reviewed medical publications or for a patient currently managed with an established treatment regimen.

(2) Third parties should be required to make preauthorization statistics available, including the percentages of approval or denial. These statistics should be provided by various categories, e.g., specialty, medication or diagnostic test/procedure, indication offered, and reason for denial.

Policy Timeline

Sub. Res. 728, A-10Reaffirmation I-10Reaffirmation A-11Reaffirmed: Res. 709, A-12Reaffirmed: CMS Rep. 08, A-17Reaffirmed: Res. 125, A-17Reaffirmation: A-17Reaffirmation: I-17Reaffirmed: CMS Rep. 4, A-21; Reaffirmation: A-22