AMA on the Rising Scope of Practice Bills and Prior Authorization Challenges

State legislatures are witnessing a surge in scope of practice expansion bills, posing challenges to physician-led, team-based care. Non-physician providers, including pharmacists, optometrists, psychologists, naturopaths, nurse practitioners, and physician assistants, are advocating for broader roles, such as prescribing medications and performing surgery, without physician involvement. Meanwhile, prior authorization reform remains a priority, with the AMA tracking nearly 100 bills at the state level aimed at streamlining the process and ensuring continuity of care.

The battle over scope of practice continues to intensify as state legislatures grapple with a wave of expansion bills proposed in 2024. After a record number of such bills surfaced in 2023, non-physician providers are once again pushing for increased autonomy, potentially undermining physician-led, team-based care.

Pharmacists are at the forefront of this movement, advocating for legislation that would grant them authority to test for and prescribe medications for various conditions. Additionally, they seek to expand their scope to include treating substance use disorder and HIV outside the purview of physician-led teams. Optometrists are pursuing bills that would grant them the ability to perform surgical procedures, while psychologists and naturopaths are seeking authorization to prescribe medications. Nurse practitioners, advanced practice registered nurses, and physician assistants are also lobbying for bills that would allow them to practice independently without physician oversight.

The American Medical Association (AMA) is actively opposing two notable trends in scope of practice legislation: proposals to replace physician supervision with vague collaboration definitions and initiatives to implement “test to treat” protocols, which would allow pharmacists to diagnose patients based on administered tests and prescribe medications accordingly.

According to AMA representative Horvath, weakening physician supervision or collaboration with non-physician providers undermines patient care by effectively removing physicians from the care team. Collaboration with employers, rather than physicians, could lead to compromised patient safety and fragmented care.

Furthermore, the notion of allowing pharmacists to engage in “test to treat” practices raises concerns about the feasibility and safety of such protocols. Pharmacists already face high workloads, with limited time for additional responsibilities. Implementing these protocols without adequate training and oversight could jeopardize patient safety and quality of care.

In addition to scope of practice issues, the AMA is actively advocating for prior authorization reform to alleviate administrative burdens on physicians and improve patient access to timely care. Last year, nine states passed bills aimed at right-sizing prior authorization requirements, with dozens more considering similar legislation in 2024.

AMA senior attorney Emily Caroll expressed optimism about the progress of prior authorization reform efforts at the state level, highlighting trends such as reducing response times for prior authorization requests and implementing continuity-of-care provisions for patients transitioning between insurance plans.

Dr. Underwood emphasized the importance of physician collaboration with the AMA in advocating for legislative changes that support physician-led, team-based care and address challenges such as prior authorization reform. He encouraged physicians to leverage the resources provided by the AMA to navigate these complex issues effectively.