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NHF Weighs Benefits of Standardized Prior Authorization Legislation

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NHF Weighs Benefits of Standardized Prior Authorization Legislation

May 1, 2014
NHF Weighs Benefits of Standardized Prior Authorization Legislation

For a patient to have access to medically recommended services or medications, medical providers may have to seek prior authorization from the patient’s insurer.  In most states, insurers are allowed to set their own prior authorization process, which can vary from insurer to insurer or even within each insurance plan offered by an insurer.1   This creates a significant administrative burden on medical providers who must comply with each plan’s prior authorization process.2   If a prior authorization form is required and not submitted, the wrong form is submitted or information is missing, this can significantly delay the approval process.    Ultimately, patients are affected when they are denied timely access to necessary services and medications. 

Recently, bills aimed at standardizing the prior authorization process for private and/or public insurers have been introduced in a number of states.  For example, in June 2013, Texas Governor Rick Perry signed S.B. 1216 and S.B. 644 into law.  Both bills developed an advisory committee to provide input to the insurance commissioner for developing a single, standard prior authorization form.3  The commissioner is required to develop and implement these forms by January 1, 2015.4 Today, there are bills pending in several states, including Missouri and Ohio. 

Having a single, standard prior authorization form for all payers helps to ensure timely access to lifesaving medications and makes sense for our community.  Accordingly, NHF’s public policy team is evaluating past and current legislation to develop proposed bill language that could be filed in states where current law does not require a standardized prior authorization form.  Consistent with existing proposals, NHF is considering including a time limit within which a payer must approve the request, a page limit for the form, the length of time the prior authorization remains valid, and a requirement that the form be available in both electronic and paper forms.

This effort will benefit the bleeding disorders community and others.  Like H.R. 460, the specialty tier legislation we have worked on with other chronic conditions groups on the federal level, standardized prior authorization benefits all patients, particularly those who require timely access to lifesaving medications.  We hope to work with our chapters on this issue and develop a strategy for working with other chronic disease groups and/or medical associations to pursue this goal. NHF’s public policy team will keep you posted as plans unfold.

1See, e.g., Testimony by Particia Kolodzey, Associate Director, Legislative Affairs for Texas Medical Association at the Texas Committee on Senate State Affairs, April 25, 2013, http://www.texmed.org/Template.aspx?id=27075.

2Ibid.

3 S.B. 1216 requires a single, standard prior authorization form for medical or healthcare services; S.B. 644 requires the same for prescription drug benefits. 

4States that currently have standardized prior authorization laws include Washington, California, Minnesota and Michigan.