The legislation is championed by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD (D-CA), and Larry Bucshon (R-IN) and Senators Roger Marshall, MD (KS), Krysten Sinema (D-AZ), and John Thune (R-SD). This bipartisan, bicameral legislation would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America’s seniors. Read the “Dear Colleague” letter sent on May 6th from the bill’s champions encouraging other Members to co-sponsor the bill. In early January 2022, the Regulatory Relief Coalition sent letters to the Committees on Ways and Means, Energy and Commerce, and Finance urging action.

Based on a consensus statement on prior authorization reform adopted by leading national organizations representing physicians, medical groups, hospitals, pharmacists, and health plans, the legislation would facilitate electronic prior authorization, improve transparency for beneficiaries and providers alike, and increase Centers for Medicare & Medicaid Services (CMS) oversight on how Medicare Advantage plans use prior authorization. Over 100 members of Congress called for such reform in a bipartisan letter to CMS in 2018. The letter was led by Representatives David P. Roe (R-TN) and Ami Bera (D-CA).