For once, Medicare is trying something that actually saves money
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More importantly, prior authorization helps promote evidence-based medicine. It curbs outdated clinical habits and reduces financial incentives to overtreat. Health plans consistently say that prior authorization aligns care with gold-standard clinical guidelines, particularly in areas prone to misuse.
Of course, the system must be designed responsibly. A well-functioning PA process should be transparent, fast, and grounded in strong clinical evidence. Decisions should be made in close coordination with the patient’s treating provider. The appeals process must be straightforward. And both public and private payers should be held accountable for improper denials or harmful delays.
When structured this way, prior authorization is far more efficient than the current “pay-and-chase” model, where Medicare pays first and tries to recover improper payments later.
Prior authorization already works in the private sector. It can work in Medicare.
Public and private payers have an obligation to steward the dollars they spend — whether those dollars come from taxpayers or premium-payers. In a system as expensive and fragmented as ours, no one can afford to keep writing blank checks for low-value care. When implemented wisely, prior authorization keeps coverage aligned with medical necessity, elevates the value of care, and helps deliver better outcomes at a sustainable cost.
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