CMS prior authorization final regulation incorporates AADA’s recommendations
Moving the needle
By Apoorva Stull, Senior Manager, Advocacy Communications, July 1, 2024
DermWorld breaks down the latest highlights of AADA advocacy activities at the federal and state legislative and regulatory level.
The AADA advocated tirelessly for prior authorization reform. As a result, several policy changes will take effect in 2026. While the regulations apply only to Medicare, Medicare Advantage, Medicaid, and CHIP plans and not to private, commercial health plans, and ERISA plans, the AADA anticipates that many private health plans will adopt similar policies.
CMS accepted many recommendations advocated by the AADA, including:
Shorter deadlines for health plans to respond to prior authorization for urgent and non-urgent requests (72 hours and seven days, respectively). The AADA supported the improved timeframes, and CMS acknowledged that stakeholders, including the AADA, advocated for faster timeframes and will consider updating its policies in future rulemaking.
Increased transparency of health plans’ use of prior authorization. Starting in 2026, impacted payers must provide a specific reason for denied prior authorization decisions as well as provide access to policies and procedures for prior authorization decisions.
Reporting prior authorization metrics. The Academy supported the CMS requirement that payers publicly report certain prior authorization metrics, including approval/denial rates and average processing time, annually on their websites beginning in 2026.
To learn more, visit our Advocacy page on prior authorization.
Additional DermWorld Resources
In this issue
The American Academy of Dermatology is a non-profit professional organization and does not endorse companies or products. Advertising helps support our mission.
Opportunities
