Ama Policy

Prior Authorization Requirements for Post-Operative Opioids: H-95.919

ERISA-Med. Nec. Decisions-Deadlines, Med. Adv.-Med. Nec. Appeals-Deadlines, Step Therapy Override

Our AMA will: (1) advocate for state legislatures and other policymakers, health insurance companies and pharmaceutical benefit management companies to remove barriers, including prior authorization, to non-opioid pain care; (2) support amendments to opioid restriction policies to allow for exceptions that enable physicians, when medically necessary in the physician’s judgment, to exceed statutory, regulatory or other thresholds for post-operative care and other medical procedures or conditions; and (3) oppose health insurance company and pharmacy benefit management company utilization management policies, including prior authorization, that restrict access to post-operative pain care, including opioid analgesics, if those policies are not based upon sound clinical evidence, data and emerging research.

Policy Timeline 

BOT Rep. 23, A-19