Oct. 3, 2025

WSMA Advocacy Spotlight: Prior Authorization

Whether it's in data from WSMA membership surveys, resolutions to the WSMA House of Delegates, or in informal conversations, WSMA members make it clear: Addressing prior authorization needs to be a top advocacy priority. We hear the message loud and clear and continue to work on multiple fronts to reduce administrative burden and patients' delays associated with prior authorization.

At the federal level, the WSMA is helping lead advocacy efforts to push back on the Medicare artificial intelligence prior authorization pilot program known as the Wasteful and Inappropriate Service Reduction (WISeR) Model. As previously reported, Washington is one of six states included in the Centers for Medicare and Medicaid Services program that is slated to begin on Jan. 1, 2026.

Earlier this week, WSMA staff met with counterparts from the American Medical Association and other states included in the pilot program. We are taking the lead on coordinating a multistate letter to CMS raising concerns with the program, asking for it to be rescinded or, at minimum, for implementation to be delayed. WSMA's executive committee will be meeting with CMS next week to express concerns, and we've been engaged with our state's congressional delegation to similar effect. WSMA physician leadership and staff were quoted in a recent Washington State Standard article that highlighted concerns with the program.

At the state level, the attorney general's AI Task Force recently voted to approve a recommendation requiring a physician be involved in reviewing and explaining prior authorization delays, denials, and modifications. Earlier this year, the WSMA presented to the health care subcommittee on the need for regulating insurance carrier use of prior authorization, which led to the formation of these recommendations. The approved recommendation is available here.

The task force recommendation dovetails with the WSMA's legislative advocacy on prior authorization reform in support of Senate Bill 5395, which was developed in conjunction with the Washington State Hospital Association and Proliance Surgeons. The bill, which among other provisions, prohibits insurance carriers from using AI to deny prior authorization requests, will be reintroduced when the 2026 session convenes in January.