Letter to Congressman Craig Goldman supporting the Prior Authorization Accountability Act
U.S. House of Representatives
1716 Longworth House Office Building
Washington, DC 20515
Dear Representative Goldman,
On behalf of the HIV+Hepatitis Policy Institute, a national organization dedicated to promoting quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other chronic conditions, we write to express our strong support for the Prior Authorization Accountability Act (H.R. 9396), which recently passed the Subcommittee on Health on a bipartisan basis. We thank you for your leadership in advancing meaningful transparency in the prior authorization process and urge Congress to swiftly pass this important legislation.
For patients living with HIV, viral hepatitis, and other serious chronic conditions, prior authorization is too often an unnecessary barrier to timely, medically appropriate care. Delays in accessing medications can result in treatment interruptions, disease progression, increased risk of transmission, drug resistance, and other irreversible health consequences. While our organization believes prior authorization should be significantly reduced across the healthcare system, greater transparency is an essential step toward accountability and reform.
H.R. 9396 would provide patients, providers, researchers, employers, and policymakers with information that is currently unavailable but critically important. By requiring commercial health plans to publicly report which drugs, items, and services are subject to prior authorization, approval and denial rates, appeal outcomes, processing times, and the growing use of artificial intelligence and other automated technologies in coverage determinations, the bill would finally allow stakeholders to evaluate how prior authorization is functioning in practice.
The reporting requirements are particularly significant because they move beyond simply measuring the volume of prior authorization requests. Patients deserve to know whether a plan routinely denies medically necessary care, how frequently those denials are overturned on appeal, how long patients wait for decisions, and whether automated technologies are making coverage determinations. This level of transparency will enable patients to make more informed health plan choices, help employers better evaluate the plans they offer, and allow regulators and lawmakers to identify plans whose prior authorization practices warrant greater oversight.
While transparency alone will not eliminate the burdens imposed by unnecessary prior authorization, it is an indispensable foundation for future reforms. Policymakers cannot effectively address inappropriate utilization management practices without reliable, publicly available data. H.R. 9396 will provide that foundation.
Thank you again for your leadership. We strongly support H.R. 9396 and respectfully urge Congress to enact this legislation. Should you have any questions or comments, please contact me at cschmid@hivhep.org or (202) 365-7725.
Sincerely,
Carl E. Schmid II
Executive Director
cc: Members, House Energy and Commerce Committee