CLEVELAND — Nearly all health insurers use "prior authorization requirements," meaning your health provider has to prove why you need what they're prescribing to your health insurer.
Health insurers use it as a cost control measure.
Now there’s a bill before the Ohio State legislature, House Bill 130, that could streamline the process.
“We know that the American Medical Association is tracking over 90 pieces of prior authorization legislation across 30 states right now and this is a topic that is important to a lot of people, not just here in Ohio. So this should be at the top of of these legislative agendas,” says Sean Humphreys.
Another medical specialty particularly impacted by prior authorization policies is rheumatology. More than 58.5 million American adults have been diagnosed with a rheumatic disease, like arthritis or lupus, that can cause the immune system to attack a person’s joints, muscles, bones, and organs.
According to a 2020 patient survey by the American College of Rheumatology, 48% of rheumatic disease patients reported being subjected to prior authorization delays or denials.
A recent study of patients who receive infusion therapies for a rheumatologic condition found that prior authorization was associated with increased treatment delays and worse health outcomes.
Humphreys battles Rheumatoid Arthritis, (RA) and had to wait for his insurance to approve new medication when the old one he was taking no longer worked.
"When you experience those delays, when you're in pain or have inflammation or in discomfort, in the case of my rheumatologist and my experience, that delay means risk of joint damage and once you incur joint damage, you really can't reverse it," Humphreys said.
Humphreys wants to see HB 130 pass in Ohio so others don’t have to wait days, weeks or months for basic or sometimes lifesaving medications or treatments.
HB 130 would streamline Prior Authorization and give a year long exemption to providers who typically have 80 percent of their requests approved. So they could avoid all the paperwork involved.
"We know on average, physicians and their clinical staff are spending about 13 hours a week dealing with the hassles of prior authorizations," said Monica Hueckel, Vice President of Advocacy for the Ohio State Medical Association.
“It's not just that expensive surgeries that we're seeing in the health care space anymore. It's everything from Tamiflu to Z packs to diabetic supplies, things that are actually pretty low cost in the health care space.”
HB 130 was introduced in March and is currently in the Insurance Committee. A number of healthcare agencies are supporting the measure and Hueckel says it’s also getting bi-partisan support in the legislature.
She expects it to come out of committee after summer.
To read the measure click here.
