It’s sponsored by Frederick County Delegate Ken Kerr.
Delegate Ken Kerr
Annapolis, Md (KM) A hearing is scheduled for Thursday afternoon on a bill dealing with prior authorizations for prescriptions and treatments ordered by doctors and dentists for their patients. “Your doctor or your dentist orders a drug or a treatment or a test or a procedure, and your insurance companies denies it,” says Frederick County Delegate Ken Kerr, one of the sponsors of this legislation. “So that’s pretty common.”
Patients can appeal this decision by their health insurance carrier. “You may be surprised that over two-thirds of the time when these are appealed, the denial is overturned, and the doctor gets the treatment of the medication for the patient that they desire,”: say Kerr.
But the appeal process usually takes time. “And what happens is that delays patient treatment that goes against what the doctor thinks is best for the patient,” he says.
The legislation, if passed, would alter or establish requirements and prohibitions related to health insurance companies’ utilization reviews. That includes provisions regarding benchmarks for standard and automating the preauthorization process, the on line preauthorization system for payers, preauthorization for prescription drugs and private review agents. It would also change time lines related to internal grievance procedures and adverse decision procedures. The bill, if it’s approved by the General Assembly, would increase penalties for violating certain provisions of the law regarding private agents.
Kerr says this legislation puts care givers and their patients as number one. “Prior authorization only lasts a year, “he says. “So this drug that the patient is stable on , and is doing well and is well tolerated, at the end of this year the physician has to put in another prior authorization request which is denied, even through it’s been demonstrated that this is an effective drug for the patient.”
The bill would require only one authorization for a prescription.
The hearing will take place at 1:00 PM on Thursday before the House Health and Government Operations Committee. Kerr says it will give lawmakers an opportunity to hear what can happen while patients are awaiting an appeal to a previous denial of payment of a prescription drug or a medical treatment. “Sometimes the patient becomes unstable, resulting in a hospitalization. In the case of at least one patient that we’re going to hear from Thursday from a physician, the patient died,”:: he says.
Delegate Kerr says he expects the insurance industry to fight this legislation “tooth and nail.” He says he will be meeting with insurance company representatives on Tuesday to find a common ground.
BY Kevin McManus