Paths Forward on Prior Authorization: Exploring Reforms in California

The project is considering the views of major stakeholders in CA on improving PA processes given recent legislative and regulatory developments. The primary project deliverable will be an assessment of reform efforts that have the greatest impact in addressing prior authorization issues, incorporating project participants’ perspectives on the feasibility of implementing these.

As a first step, NEHI updated its previous literature scan on prior authorization to include:

• Background on the California healthcare market and prior authorization practices;
• A literature scan on prior authorization’s utility and issues; and
• A discussion of federal, state, and voluntary prior authorization proposals and reforms over the last decade.

Read the updated report here.

NEXT: NEHI is currently interviewing California stakeholders (e.g., payers, providers, and consumers) in November 2023 and will host its next advisory committee meeting in December 2023 to discuss interview findings and begin considering feasible prior authorization reforms.

NEHI will publish a final report that completes our project deliverable in March 2024.  Please check back then!

.

Additional Contributors:

Project Sponsors: