Work Continues On Prior Authorization Bill

A hearing was held on it earlier this month.

Delegate Ken Kerr

Annapolis, Md (KM) Work is continuing on developing a bill which deals with prior authorization. That’s when  physicians prescribe medications for their patients, and they’re filled by a pharmacy. But the patients’ insurance companies  refused to cover it. “When a patient has been on a drug for a year, and the drug is proven effective, the patient’s  stable, living a normal healthy life. But after the year is up, the physician has to request another authorization for the same drug that the patient is on and is stable,” says Frederick County Delegate Ken Kerr, the bill’s sponsor.

He says the patient can appeal the insurance company’s decision, but that process can be very lengthy. “So even though the patient is thriving on the drug, they have to go through an appeal process, that in the best cases, can take days, usually takes weeks, and in the worst cases, takes months,” says Kerr.

And that could  have unfortunate consequences, particularly for those who are taking auto-immune drugs. “While the patient is waiting for the appeal to be resolved, they run out of medication, and it frequently results in a hospitalization, or the patient missing work, unable to carry on the tasks of daily life,” he says.

The House Health and Government Affairs Committee held a hearing on this bill on February 16th, and Kerr says legislators heard a lot of similar stories. . “We heard from many physicians about how their patients have suffered, and the difficulties they’re having effectively caring for their patients because of these prior authorizations,” he says.

But Delegate Kerr says he will continue to work with physicians, pharmacy benefit managers and insurance company representatives to come up with a compromise bill. “Since the hearing’s been over, we had another debrief to find areas where we can compromise. We made a little bit of progress,” he says.

“So what we’re trying to do is just to establish some reasonable boundaries around when an insurance company  can deny a medicine, and how long the appeals process can take. and who the person who’s  qualified to deny the prior authorization request,” says Kerr.

By Kevin McManus