RICHMOND – Doctors, hospitals and patients frequently face frustration and delays because health insurers require preauthorization before patients can obtain many prescription drugs. Different insurers use different preauthorization forms – and it’s done on paper, not electronically.
Two Republicans – Sen. Steve Newman of Lynchburg and Del. Greg Habeeb of Salem – have proposed legislation aimed at solving the problem. Senate Bill 1262 and House Bill 1942 would:
- Require health plans to use a common preauthorization form to be developed by the State Corporation Commission
- Permit the electronic submission of preauthorization requests
- Waive preauthorization requirements for drugs to manage chronic diseases and treat mental health problems
- Limit when prior authorization may be required for generic drug benefits
The provisions would apply not only to private health insurers but also to Medicaid and state employee health plans.
Last week, doctors and other groups announced their support of the bills. They said the legislation would make it easier for patients to get the medications they need when they need them. And the measures would free physicians, nurses and other clinical staff to spend more time with patients or see more patients every day.
At a press conference Thursday, Newman said a lot of time and thought went into the idea. He is hopeful that the various stakeholders in the health care industry would work together to carry it out.
“We are looking for a common form,” Newman said. “Wouldn’t it be good for the insurance company to have a common form that could be filled out for prior authorization?”
The bills would set a 48-hour deadline for health insurance carriers to approve, deny or request supplemental information for prior authorization for a prescription. Once they get the supplemental information, insurers would have 24 hours to approve or deny the request.
“The 48-hour requirement, to me, is a critical element of this bill,” Newman said.
The legislation received endorsements from the Medical Society of Virginia, the Psychiatric Society of Virginia and the D.C.-Maryland-Virginia chapter of the Lupus Foundation of America.
William C. Reha, president of the medical society, said that existing preauthorization processes can be confusing and that insurers can be slow in responding to requests for prior approval of prescriptions. This can delay patients’ access to needed treatments, Reha said in a statement.
“When changing health plans, patients can be required to repeat failed therapies to gain access to a medication that has already proven effective,” he said. “This can be detrimental.”
The medical society said that just prescribing medication or refilling a prescription can necessitate numerous emails, phone calls, faxes and website visits – not to mention filling out and submitting the forms.
Penny Fletcher of the Lupus Foundation of America urged Virginians to support the legislation so that people with chronic diseases can live a more normal life.
“Our patients get sicker while waiting for approval. We urge that this moves as a top priority because of what is doing to Virginians. So I hope that it will be seen as a very patient-centered issue as this bill moves forward,” Fletcher said.
SB 1262 is awaiting a vote by the Senate Commerce and Labor Committee. HB 1942 has been assigned to the corresponding committee in the House.
