Rep. Bresnahan pushes for prior authorization reform in Congress

Sep. 30--WILKES-BARRE -- U.S. Rep. Rob Bresnahan, R-Dallas Township, announced Wednesday he has co-sponsored several pieces of legislation intended to speed up insurance approval processes and hold health insurers accountable when treatment doctors say patients need is delayed or denied.

"Families pay their premiums every month and shouldn't have to fight with an insurance company to get the care their doctor says they need," Bresnahan said. "We need reforms that cut red tape, hold insurance companies accountable, and make sure medical decisions are driven by doctors and patients, not the bottom line."

Bresnahan also said prior authorization is meant to help insurers manage costs and ensure certain treatments meet coverage requirements, but the process has created significant administrative and access challenges.

In a 2024 American Medical Association survey cited by Bresnahan, 94% of physicians said prior authorization delays access to necessary care, while physicians reported spending an average of 12 hours per week completing prior authorization requests.

Additionally, Bresnahan noted a 2022 HHS Office of Inspector General review found that 13% of sampled Medicare Advantage prior authorization denials met Medicare coverage rules, meaning those services likely would have been approved under traditional Medicare.

"Insurance companies operate in a multi-billion-dollar market, but patients are not dollar signs," Bresnahan said. "Doctors should not have to spend hours fighting with insurers over treatments they have already determined are medically necessary. We can protect taxpayer and premium dollars without letting insurance companies put profits ahead of care. Prior authorization reform is about putting patients first and giving doctors the ability to do their jobs."

To combat the delays in necessary care, contributions to patients abandoning recommended treatment, and added time from doctors and their staff, Rep. Bresnahan cosponsored:

--H.R. 3514 -- Improving Seniors' Timely Access to Care Act of 2025: which establishes requirements for prior authorization in Medicare Advantage, including electronic prior authorization, faster decision timelines, transparency requirements, and greater accountability for MA plans.

--H.R. 2433 -- Reducing Medically Unnecessary Delays in Care Act of 2025: which establishes stricter federal standards for prior authorization decisions made by Medicare contractors and private Medicare plans. This bill mandates that coverage denials must be based on clear, evidence-based clinical criteria developed with input from practicing physicians. Furthermore, it requires plans to post their authorization rules online, provide advance notice of changes, and publicly report approval and denial statistics. Finally, all final denials of care must be reviewed and issued by a qualified, board-certified physician.

--H.R. 9396 -- Prior Authorization Accountability Act: which requires insurers that use prior authorization to publicly disclose approval and denial rates, appeal volumes and outcomes, average and median decision times, and the percentage of decisions made using AI or other specified technology.

--H.R. 9734 -- Protecting Patients from Automated Denials Act: which establishes requirements for the use of artificial intelligence in prior authorization denials by Medicare Advantage organizations.

--H.R. 9192 -- Prior Authorization Reform for Autoimmune and Blood Disorders Act: which addresses insurance coverage and prior authorization barriers involving drugs for autoimmune diseases and certain blood disorders.

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Reach Bill O'Boyle at 570-991-6118 or on Twitter @TLBillOBoyle.

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