Gov. Matt Bevin has signed into law “a bill that’s expected to ease the process for getting some medications and treatments pre-approved by insurers,” Darla Carterreports for Insider Louisville.
Senate Bill 54 could speed up the authorization process “to five days or less, along with other enhancements,” Carter writes, and quotes Dr. Bruce Scott, a Louisville ear, nose and throat physician who is president of theKentucky Medical Association.
“Five days is a considerable improvement for our patients,” Scott said. “It’s still five days of stress and five days of waiting, but that’s a whole lot better than what we used to have, which could often stretch on for weeks.”
KMA says the bill, sponsored by Republican Sen. Ralph Alvarado, a Winchester physician, targets “a process that has become onerous to medical providers and patients alike, with doctors’ office staffs sometimes spending hours on hold waiting to hear back from insurers,” Carter writes.
Scott told her the process can lead patients “to abandon treatments that are recommended by their doctors, and it adds stress to patients who are waiting for approval of a medication, a treatment, a diagnostic study that their trusted physician has recommended to them.”
An American Medical Association survey “found that nearly 30 percent of physicians report that the prior-authorization process required by health insurers has led to serious or life-threatening events for patients,” Carter reports. “The survey of 1,000 practicing physicians also found that more than a third of physicians employ staff strictly to work on pre-authorization tasks.”
Insurers say they have an obligation to keep costs down. “Stephanie Stumbo, acting executive director of the Kentucky Association of Health Plans, reminded members of the House Banking and Insurance Committee that insurance companies also have to deal with headaches related to prior authorization,” Carter writes.
The bill takes effect Jan. 1. It will require health plans to make decisions about urgent services within 24 hours of getting the necessary information, and on non-urgent services within five days. Scott told Carter the insurers “pushed for seven days, and the bill was originally written at 72 hours [three days], and we compromised with five days.”
Prior authorizations for maintenance drugs, usd to treat chronic conditions, will be good for a year, with some exceptions, including opioid painkillers and benzodiazepines (minor tranquilizers).