Bill Proposes Physician-Led Prior Authorization to Reduce Care Delays

The Reducing Medically Unnecessary Delays in Care Act of 2025 has been reintroduced in the U.S. House of Representatives, aiming to mandate that prior authorization decisions under Medicare are made by physicians rather than non-medical staff. The bill requires Medicare, Medicare Advantage, and Medicare Part D plans to base preauthorization restrictions on clear medical necessity and written clinical criteria, developed with input from physicians practicing in the relevant service areas. This legislative effort has bipartisan support, with lawmakers from both parties collaborating to ensure patient care decisions remain with physicians. Major medical associations back the bill, emphasizing the significant negative impacts prior authorization has on patient care, including hospitalizations and potentially life-threatening delays. The bill's sponsors highlight how bureaucratic hurdles in prior authorization processes disrupt timely access to necessary medical treatments and advocate for streamlining these procedures to improve healthcare outcomes. The timing of the bill's reintroduction corresponds with recent findings showing a high denial rate of in-network claims by health insurers in 2023, notably affecting pathology and clinical laboratory services. Industry stakeholders are engaging in discussions and educational initiatives to address prior authorization challenges, emphasizing collaborative and programmatic solutions.