PA-ACP and Patient Coalition Spur Unanimous Passage of SB 225 from Senate Committee

PA-ACP today thanked both Chairman John DiSanto, prime sponsor Sen. Kristin Phillips-Hill, and the entire Senate Banking and Insurance Committee for its unanimous support in moving SB 225, which would make significant reforms in the standardization and processes for prior authorization and appeals in the Commonwealth.

PA-ACP has had prior authorization reform as a top legislative priority for three sessions, and has been working with key committees and leadership to move these reforms.  In recent months, stakeholder meetings, drafting meetings and negotiations with insurers have all been stepped up, and insurers were forced to state their objections to these reforms.

The Chapter was joined by a coalition of more than 65 medical, hospital and patient advocacy organizations in seeking the action.  This is the first time a legislative committee has agreed to consider this legislation, and SB 225’s approval by the committee  is a major step forward for patient care, access to therapies and reducing administrative burdens for physicians.

Larry Jones, MD, FACP, Eastern PA Governor and President of PA-ACP Services, Inc. told Chairman DiSanto, “This legislation makes important reforms in how medical treatments and processes are approved by insurers.  Current practices for prior authorization, which vary from insurer to insurer, delays internists’ ability to treat patients, and jeopardizes safe, timely care.”

PA-ACP supports standardization of the processes to enhance the electronic exchange of information and reduce burdensome paperwork.  The average medical practice loses two days a week to these administrative costs.  PA-ACP has long supported a standard form for all insurers, increased transparency and consistency in prior authorization criteria, creates standardized definitions for those criteria, and should reduce the overuse of prior authorization.

“An amendment supported by the Chapter establishes a minimum approval duration period to expedite the prior authorization process, reduces administrative burdens for physicians, and ultimately, better serves our patients. It also establishes a basic framework for when it is medically appropriate to exempt patients from step therapy, as well as an exceptions process that is both transparent and accessible to patients and health care providers,” according to Dr. Jones.

The bill:

  • Ensures physicians and other prescribers have access to more efficient electronic prior authorization systems (“ePA”)
  • Establishes a basic framework for when it is medically appropriate to exempt patients from fail first, as well as an exceptions process that is transparent and accessible to patients and health care professionals
  • Provides deadlines for insurers to render decisions on prior authorization requests

“Patients and their healthcare providers should make medical decisions, not insurance companies. Unreformed practices like step therapy can cause delays in care that are determinantal to the health of patients. Unanimous passage of this bill out of the Senate Banking and Insurance Committee today shows that our legislature is committed to putting patients first,” said Emma Watson, Pennsylvania Government Relations Director for American Cancer Society Cancer Action Network.

A recent study of Pennsylvania family physicians showed that prior authorization causes delays in patient care 98 percent of the time.  According to a recent survey of physicians by the American Medical Association, the negative impact of processing prior authorization requests on patients is clear. A staggering 78% of patients report prior authorization delays can lead to them abandoning their treatment. And 92% of doctors report prior authorization delays can have a negative clinical impact on patients.

Prior Authorization costs physician practices on average at least 20 hours a week including at least one hour of the doctor’s time, nearly six hours of clerical time, plus 13 hours of nurses’ time. Other studies show that prior authorizations cost individual  practices tens of thousands of dollars a year.