Findings on Insurance Reported by Investigators at University of Minnesota (The Extent and Growth of Prior Authorization In Medicare Advantage): Insurance

Health Policy and Law Daily

2024 OCT 30 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Fresh data on Insurance are presented in a new report. According to news reporting out of Minneapolis, Minnesota, by NewsRx editors, research stated, “To assess trends in the use of prior authorization requirements among Medicare Advantage (MA) plans. Descriptive quantitative analysis.”

Our news journalists obtained a quote from the research from the University of Minnesota, “Data were from the CMS MA benefit and enrollment files for 2009-2019, supplemented with area-level data on demographic and provider market characteristics. For each service category, we calculated the annual share of MA enrollees in plans requiring at least some prior authorization and plotted trends over time. We mapped the county-level share of MA enrollees exposed to prior authorization in 2009 vs 2019. We quantified the association between local share of MA enrollees exposed to prior authorization and characteristics of that county in the same year. Finally, we plotted the share of MA enrollees exposed to prior authorization requirements over time for the 6 largest MA carriers. From 2009 to 2019, the share of MA enrollees in plans requiring prior authorization for any service remained stable. By service category, the share of MA enrollees exposed to prior authorization ranged from 30.7% (physician specialist services) to 72.2% (durable medical equipment) in 2019, with most service categories requiring prior authorization more often over time. Several area-level demographic and provider market characteristics were associated with prior authorization requirements, but these associations weakened over time. The use of prior authorization varied widely across plans. In 2019, roughly 3 in 4 MA enrollees were in a plan requiring prior authorization.”

According to the news editors, the research concluded: “Service-level, area-level, and carrier-level patterns suggest a wide range of approaches to prior authorization requirements.”

This research has been peer-reviewed.

For more information on this research see: The Extent and Growth of Prior Authorization In Medicare Advantage. The American Journal of Managed Care, 2024;30(3). The American Journal of Managed Care can be contacted at: Managed Care & Healthcare Communications Llc, 666 Plainsboro Rd, Ste 300, Plainsboro, NJ 08536, USA.

Our news journalists report that additional information may be obtained by contacting Hannah T. Neprash, University of Minnesota, School of Public Health, Division of Health Policy and Management, 420 Delaware St S.E., Mmc 729, Minneapolis, MN 55455, United States. Additional authors for this research include John F. Mulcahy and Ezra Golberstein.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.37765/ajmc.2024.89519. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.