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HAP and PA Coalition Fight Harmful Delays in Care from Prior Authorization

June 09, 2021

HAP and a coalition of the state’s leading health care organizations are calling on lawmakers this week to address harmful delays in care stemming from prior authorization.

Across the state, needless delays in care from insurer prior authorization processes are hurting Pennsylvanians as patients wait for their insurers to approve medical tests, hospital admissions, prescription drugs, and other necessary medical equipment.

Introduced in February, Senate Bill 225, sponsored by Senator Kristin Phillips-Hill (R-York), and House Bill 225, sponsored by Representative Steven C. Mentzer (R-Lancaster), would make the prior authorization process more efficient and provide clarity for both patients and providers.

“The current preauthorization process has become overly expansive, to the point where it is interfering with the patient-provider relationship by inserting a third party into the treatment decision-making process,” the legislation notes.

Among other things, such as more timely decision-making by insurers, this legislation addresses a form of prior authorization, known as “step-therapy protocol,” that requires patients to try one or more insurer-preferred medications before coverage is granted for a health care provider’s recommended course of treatment. This process directs patients to less costly therapies that may not address their individual needs and results in critical delays in medical care.

House Bill 225 and Senate Bill 225 would:

  • Ensure prescribers have access to more efficient electronic prior authorization systems and establish minimum approval times to expedite the prior authorization process
  • Ensure fail first protocols are based on clinical guidelines developed by independent experts
  • Establish a basic framework for when it is medically appropriate to exempt patients from fail first protocols, as well as an exceptions process that is transparent and accessible to patients and providers

The legislation does not prevent insurers from requiring prior authorization or step therapy, but it brings transparency and consistency to the approval process.

HAP and The Coalition to Improve Prior Authorization and Step Therapy for Pennsylvanians encourage people across the commonwealth to get involved today in the advocacy effort to support this legislation. Resources to support the initiative are available online.

HAP continues to support federal and state initiatives to reform prior authorization and ensure that all patients have timely access to care.

To get involved in the advocacy campaign to support this legislation, contact Sarah Lawver, HAP’s director, advocacy activation. For more information about prior authorization, contact Jolene Calla, Esq., HAP’s vice president, health care finance and insurance.