Trends in Prior Authorization Among Medicare Advantage Plans

A recent report analyzed trends in prior authorization requirements among Medicare Advantage (MA) plans, focusing on data from 2009 to 2019. The study, conducted by researchers at the University of Minnesota, aimed to quantify how many MA enrollees were exposed to prior authorization across different service categories and to examine the associated demographic and market characteristics. The findings indicated that while the share of MA enrollees in plans requiring prior authorization remained stable overall, there were variations depending on service categories, with durable medical equipment having the highest requirement rate at 72.2% in 2019.

The research also revealed that the use of prior authorization varied significantly across different MA plans and that demographic and provider market characteristics influenced these requirements, although the strength of these associations weakened over time. The study concluded that there is a diverse range of approaches to prior authorization among MA plans, emphasizing the complexity of these requirements in the healthcare system.

The findings were published in The American Journal of Managed Care, indicating a comprehensive peer-reviewed examination of the usage and implications of prior authorization in the healthcare landscape within Medicare Advantage.