AMGA Calls for Prior Authorization Reforms

Supports Coverage of Anti-obesity Drugs in Medicare Advantage Proposed Rule

Alexandria, VA – AMGA today recommended eliminating where possible the use of prior authorization in the Medicare Advantage program. In comments on the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage and Part D proposed rule for 2026, AMGA expressed concern about the burden associated with prior authorization.

 “Over the past few years of rulemaking, CMS has moved to collect more information and data on how prior authorization affects patients, particularly those with social risk factors,” said AMGA President and CEO Jerry Penso, MD, MBA. “This data will be useful, but it’s going to confirm what AMGA members already know. Prior authorization creates a barrier to care, and those who are least able to navigate an appeals process will be impacted the most.” 

Prior authorization has the potential to negatively affect underserved communities. Under the proposed rule, Medicare Advantage plans would need to analyze how their prior authorization processes affect beneficiaries with identified social risk factors, comparing them to beneficiaries without such factors. AMGA supports efforts to better identify trends in the use of prior authorization to address its impacts on enrollees, but eliminating measures or evaluations, rather than adding additional ones, would better serve patients and providers, while also addressing health equity concerns. 

Elsewhere in the rule, AMGA supports CMS’ proposal to permit Medicare D and Medicaid coverage of anti-obesity medications. Obesity is a chronic disease, and AMGA appreciates CMS’ efforts to ensure Medicare and Medicaid provides coverage of medications to treat beneficiaries with obesity.

The letter is now available on AMGA’s website. 

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About AMGA

AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans. 

AMGA represents medical groups and integrated systems of care. Its diverse membership includes multispecialty medical groups, integrated delivery systems, accountable care organizations, and other entities committed to improving healthcare outcomes. AMGA advocates for the formation of innovative, clinically integrated systems of care that advance population health, enhance patient experience, and reduce healthcare costs. For more information, please visit www.amga.org.