Sen. Ujifusa, Rep. Tanzi bill seeks to protect patients from prior authorizations, used to limit health care

 

STATE HOUSE – Sen. Linda Ujifusa and Rep. Teresa A. Tanzi are sponsoring legislation to require study and improved control of health insurers’ use of prior authorization to limit health care. 

A prior authorization (PA) is an approval from a health insurance plan that the insurer may require before it will cover a service or prescription.

“Insurers claim that PAs save money and lower prescription drug use,” said Senator Ujifusa (D-Dist. 11, Portsmouth, Bristol), “but studies do not show PAs help patients achieve better health, and health care providers believe PAs actually increase health care costs by preventing timely delivery of medically necessary care.”

According to a recent survey of physicians by the American Medical Association, 89% reported PAs had a negative impact on patient clinical outcomes, 94% reported PAs delayed necessary care, and 80% reported PAs led to patients abandoning a recommended course of treatment.

“The Office of Health Insurance Commissioner currently has an Administrative Simplification Task Force that is looking into reducing prior authorization burdens on patients and providers,” notes Representative Tanzi (D-Dist. 34, South Kingstown, Narragansett). “Our bill simply requires that it focus on prescription drug prior authorizations because these are by far the most common PAs faced by primary care providers.”

The legislation directs the group to issue a report on prescription drug prior authorization by Jan. 1, 2025.  

There is a hearing scheduled for the House bill (2024-H 7623) before the House Health and Human Services Committee Thursday. The Senate bill is expected to have a hearing this spring.  The sponsors encouraged patients who have been adversely affected by prescription drug prior authorizations to submit testimony to This email address is being protected from spambots. You need JavaScript enabled to view it., using the instructions found here.

 

 

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