Imagine being diagnosed with a chronic health condition — one that interferes with your daily life and makes even the simplest tasks a challenge. Fortunately, your physician has prescribed a treatment or medication that’s expected to make your condition much more manageable.
But then you’re shocked to learn that you have to wait for days or even weeks for your health plan to approve the treatment. All the while, you’re stuck in limbo.
There’s even a chance that, in the end, your insurer will decide not to cover the treatment, bringing you back to square one. This confusing process, called prior authorization, leads many individuals to ask just who is determining their health care needs: their trusted physician or an insurance company?
Bruce Scott, M.D.
Many Kentuckians don’t have to imagine such a scenario because they’ve experienced it firsthand.
The good news? With the passage of Senate Bill 54, legislation sponsored by Senator Ralph Alvarado, these delays and barriers to care should become the exception instead of the norm.
During this year’s session, our state representatives did the right thing, putting patients first and passing legislation that brings much-needed improvements to a prior authorization process that’s outdated, inefficient, and can harm patients.
Don’t just take my word for it, though.
A 2018 American Medical Association survey of 1,000 physicians found that prior authorization can be a major detriment to care. 91 percent of respondents reported that prior authorization negatively impacts patients’ clinical outcomes, and 75 percent reported that prior authorization can lead patients to abandon treatment.
When SB 54 goes into effect, Kentuckians will face fewer obstacles to access the care and treatments they need. Patients and providers will receive responses on prior authorizations within 24 hours for urgent health care services and within five days for non-urgent services—a significant departure from existing prior authorization guidelines in Kentucky that could delay care for weeks.
In addition, patients’ prescriptions for maintenance drugs will be valid for one year or until the last day of coverage, and any change in dosage during the period of authorization will be covered—no need for another prior authorization.
Ultimately, SB 54 will help reduce providers’ mounting administrative tasks and paperwork, giving us more time to do what matters most in our line of work: caring for patients. At the same time, patients will be able to more quickly access the treatments we recommend.
The Kentucky Medical Association commends Sen. Alvarado—a fellow physician — for sponsoring this important legislation and the General Assembly for passing it with overwhelming majorities in both chambers. When we pass policies that put patients first, everybody wins.
Bruce Scott, M.D., is president of the Kentucky Medical Association.
Sen. Alvarado has a record of sponsoring self serving bills and could the devil be in the details here. The insurance companies are still very much involved in these cases and can the state tell the insurance companies what to do. I don’t understand how it can be enforced.