A Message from the Maryland Health Care Commission: "Maryland Health Care Commission Issues Reports on Increasing Primary Care Investment and Enhancing Prior Authorization Processes"

The Maryland Health Care Commission (MHCC) released two reports required by the Maryland General Assembly, about primary care and prior authorization, with recommendations aimed at improving transparency and reducing disparities in Maryland.

“All Marylanders deserve timely access to the care they need, and the foundation of any high-functioning health care system is primary care,” said Dr. Douglas Jacobs, MHCC Executive Director. “Improving access to primary care and increasing the efficiency, transparency, and accountability in the use of prior authorization can reduce wait times, support better health, and an overall experience of our health care system.”

The Primary Care Investment Report highlights stagnating investment in primary care, which contributes to workforce shortages, provider burnout, limited access to care. It underscores the essential role of primary care in reducing disparities and improving health outcomes, and reviews initiatives implemented by nearly 20 states to address challenges in increasing primary care investment. An analysis conducted by MHCC identifies trends among payors and geographic regions in Maryland that present the greatest opportunities to improve access, enhance quality, and reduce disparities through increased investment in primary care.

Additional steps are needed to improve investment in primary care in Maryland. Over the next year, MHCC will collaborate with payors to establish a statewide investment target. The MHCC also plans to analyze the factors that drive variations in spending and identify targeted opportunities to strengthen primary care commitments, with a focus on underserved communities. The MHCC will work with the legislature on additional reforms.  



The Prior Authorization Report includes findings on payors’ and pharmacy benefits managers’ implementation of a State-mandated online process that enables real-time benefit checks at the point of prescribing. Compliance requires use of national standards by July 1, 2026. The online process will streamline prior authorizations by enabling the acceptance and approval of prior authorization requests, identifying patient out-of-pocket costs, and suggesting medication alternatives.

Prior authorization reform at the federal and state levels informed MHCC’s recommendation for greater transparency. The MHCC will explore regulatory options in collaboration with partners across the state to ensure that the coverage criteria used by payors to determine medical necessity is publicly available and grounded in widely accepted treatment guidelines and high-quality clinical literature. The MHCC plans to build provider awareness of electronic prior authorization and real-time benefit check tools to reduce burden on providers and patients, and to improve timely access to care.

More information about MHCC can be found at: https://mhcc.maryland.gov/mhcc/default.aspx

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The Maryland Medicaid Office of Pharmacy Services is currently accepting applications for physicians, pharmacists and consumer members. Apply here today!

The committee is composed of five physicians, five pharmacists and two consumers living and working in Maryland. They review the Maryland Medicaid preferred drug list and make recommendations to the Secretary of Health for Maryland twice a year. Our meetings are held virtually on the first Thursday of November & May.