A Session of Slow Growth for Prior Authorization

2015-07-10 | CSRO

July 1, 2015 - There has been little movement on the Prior Authorization front this legislative session. Much of the discussion has been bogged down in the details of the individual insurance companies protesting all or part of many of these complex bills.

The focus of the bills has mainly come down in two categories, developing a uniform prior authorization form to streamline the process and reduce some of the administrative burden, and adding additional transparency to the prior authorization process so regulators and patients can have a better understanding of when and how determinations are made.

On the transparency side, only SB 118 out of South Dakota managed to get passed. Bills in Rhode Island, Connecticut, Arkansas, Florida, Hawaii and Iowa all failed to advance this session or are currently idle in their legislatures.

On the uniform prior authorization front, bills in Missouri, New York, and Texas all failed to advance. In Minnesota, a bill did make it out of committee but was rolled into an omnibus healthcare bill that essentially washed out all prior authorization provisions. At the same time, outside of the legislative arena, there has been an unfortunate trend within states which previously passed uniform prior authorization forms. Insurance companies in those states have in some cases, universally rejected all short forms within the review deadline to request more information. This effectively cancels out any gains from the form and requires providers to go back through secondary data supplement forms to fulfill their request.

Outside of the main arena, two more bills did have a little brighter future with SB 1106 passing in Hawaii which extends prior authorization protections already in law for Hep-C, HIV, and transplant patients to additional health plans. In Oklahoma, HB 1628, also passed which increases the regulatory review of prior authorization practices, requires insurers to re-evaluate prior authorization drugs more regularly, and adds a response time frame of 24 hours for emergency requests.

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