Prior Authorization and Utilization Management Reform Principles
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Prior Authorization and Utilization Management Reform Principles
Recognizing the investment that the health insurance industry will continue to place in these programs, a multi-stakeholder group representing patients, physicians, hospitals and pharmacists has developed the following principles on utilization management programs to reduce the negative impact they have on patients, providers and the health care system. This group strongly urges health plans, benefit managers and any other party conducting utilization management (“utilization review entities”), as well as accreditation organizations, to apply the following principles to utilization management programs for both medical and pharmacy benefits. They believe adherence to these principles will ensure that patients have timely access to treatment and reduce administrative costs to the health care system.