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Prior Auth’s new price tag, more work ahead

March 6, 2023

What’s new: Last week, the Congressional Budget Office (CBO) released an updated informal score of $10 billion for the prior authorization legislation.

Why it matters: $10 billion is less than the initial score of $16.2 billion for the Improving Seniors Timely Access to Care Act, but is still too high and will stimy progress. The House passed the legislation overwhelmingly last year, but the Senate did not act despite significant bipartisan support.

 What’s next: Bill champions continue to engage with CBO to:

  • understand their methodology, which is still unclear,
  • ensure consideration of CMS’s impact study, and
  • ultimately reduce the score to pave the way for final Congressional passage.

Bottom line: CMS proposed a prior auth rule in December that addresses the bulk of the legislation.  Successful finalization of this rule is now paramount for driving prior auth reforms.

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