Prior Authorization Reform – SB 225 - Passes General Assembly

 (October 27) -- The General Assembly has passed prior authorization reform legislation and it is on the Governor’s desk after seven years of efforts working with stakeholders in the health care industry and the Wolf Administration,

PA-ACP President  Larry Jones, MD, FACP, praised the General Assembly for its action, noting, “SB 255 makes critical changes in how medical treatments and processes are approved by insurers. Current practices for prior authorization, which vary from insurer to insurer, often delay internists’ ability to treat patients, jeopardizing optimal, timely care.”

Jones noted special thanks to Sens. Kristin Phillips-Hill, the prime sponsor, and Kim Ward, and Representatives Bryan Cutler, Kerry Benninghoff and Tina Pickett for helping get the reform bill over the finish line.  The legislative champions made this happen, he said.  Their direct involvement was essential to getting this done.  SB 225 passed both chambers unanimously.

“The state’s internists supported the changes which expand insurers’ transparency, define clinical standards, formalize time frames for decisions, cover additional closely related services, step therapy and medication assisted treatments.  These changes will help protect patients, improve outcomes, and reduce administrative burdens for physicians, allowing us to spend more time on patient care,” he said.

PA-ACP led a coalition of more than a dozen physician organizations, HAP and dozens of patient advocacy groups in getting the bill to the finish line.  Thousands of hours of meetings and negotiations were involved with Highmark, Capital and Independence Blue Cross, UPMC, Highmark, Geisinger, the state’s commercial insurers, state agencies and legislators to arrive at the finished product.

Senator Kristin Phillips-Hill (R, York) said “The system is broken, but Senate Bill 225 fixes it.”  In offering the final language of the bill on the House floor October 26, Representative Tina Pickett (R,  ) who chairs the House Insurance Committee called the bill “the “most expansive change in two decades” for improving patient care.”

A recent survey of physicians by the American Medical Association found 78% of doctors said that prior authorization delays can lead to their patients to abandoning their treatment, Phillips-Hill said.

Senate Bill 225 will require insurers to provide timely approval for both urgent and non-urgent health care services to physicians before services and treatment plans are rendered. The bill also requires electronic processing, public posting of medical policies, formularies and services requiring prior authorization and creates streamlined guidelines for step therapy and prescription drugs.

View Summary, which explains the positive changes included.