A little more than a year ago, HHS Secretary Robert F. Kennedy, Jr. claimed that eight in ten health insurers had made deals with the administration to reduce their use of prior authorization. While the deals sound good, there was no there there, Stephanie Armour reports for KFF Health News.
For one, each insurer decides when to use prior authorization, both for which treatments and how frequently. Each insurer also establishes the criteria for denying or approving care. And, insurers can use prior authorization more or less throughout the year.
The public, in turn, has no clue which insurers use prior authorization for which services or the criteria the insurers are relying on. So, “reducing” use of prior authorization actually tells you very little. The Centers for Medicare and Medicaid Services has said it will display a public dashboard illustrating insurers’ use of prior authorization. That has yet to happen.
Prior authorization, if not eliminated, should at least be fully transparent and standardized across all insurers, so insurers can’t play with it to boost their profits, as they appear to do.
People who don’t like government regulation might find the Trump administration’s public-private voluntary agreements appealing. Republicans tend to love these voluntary agreements. They sound good to the public.
Once the “deals” are made, the administration can claim victory. But, because they are short on details and unenforceable, they are empty promises. And, they are not working. They have no teeth. That said, it takes time to pass and implement federal regulations.
Moreover, industry might not comply with regulations. Too often, regulations do not come with meaningful oversight and enforcement. Penalties for noncompliance are often inadequate to deter noncompliance.
The Trump Administration had also entered into voluntary agreements with prescription drug manufacturers to lower their prices for newer drugs to levels people in other wealthy countries pay. And, those agreements also have not brought down drug prices.
Similarly, the Trump administration said it had entered into agreements with several food manufacturers to end a number of dyes in processed foods. But, as of yet, more than 70 percent of the manufacturers have done nothing to remove the dyes. Recently, the FDA extended the deadline for companies to respond until the end of 2027 from the end of this year.
At the same time, the Trump administration is allowing food companies to say their products have no artificial colors when they do, so long as they don’t use petroleum-based dyes. It’s Orwellian. The administration simply redefined “artificial colors” to exclude an array of artificial colors.
Here’s more from Just Care:
- Who will TrumpRx help?
- Trump administration bolsters Medicare Advantage insurer overpayments in 2027
- One-third of drugs on TrumpRx cost more than in UK
- Trump administration makes it easier for Medicare Advantage insurers to mislead enrollees
- Trump administration proposes rule that would take benefits from people with SSDI
