Good Things Come to Those Who Wait (and Stay Involved)
By Hugh M. Bryan III, MD
MSV Past President
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Hugh M. Bryan III, MD |
Prior authorization requirements by insurance companies for medications, testing and surgery have been a tremendous drain on the time of all physicians and our staffs. In addition, these roadblocks result in delay in patient care and, on occasion, harm to our patients. When this issue was first presented as a possible legislative agenda item while I was President-Elect of MSV and Chair of the MSV Legislative Committee, I looked at the expense of prior authorization in my office. As a solo practitioner, my office spent 40 hours during one month dealing with these requirements. That is a full week of a full time employee in a small office. During that month, only one MRI was denied and that decision was reversed after a “peer-to-peer” request (with an additional cost of 10 min of physician time!). Stories like mine are common. They demonstrate incredible wastes of physician and insurance company resources as result of these requirements.
Over the last three years, MSV has the background research. It has identified the right message for legislators and the public and it has identified the legislators who are best able to secure passage. MSV, along with various stakeholders, developed a winning strategy.
The result is HB 1942/SB 1262 – prescription prior authorization reform bills which were introduced by Del. Greg Habeeb (R-Salem) and Sen. Steve Newman (R-Lynchburg). These bills will require a 24-hour turnaround on urgent requests, and a two business day deadline for standard requests. If an insurer needs additional information, there will be a two business day extension for action upon receipt of supplementation. Health plans will be required to accept electronic prescription prior authorizations that can be transmitted by electronic medical record, e-prescribing or health information exchange. A physician can request a tracking number, so they may track the status of their prior authorization request. When a prior authorization is denied, the plans must provide a reason for denial. If a patient switches health plans, the new plan must honor an approved prior authorization for at least 30 days. All formularies, medications subject to prior authorization, prior authorization procedures and prior authorization forms must be located on one page on a health plan’s website.
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Hugh M. Bryan III, MD, Past President of MSV (left) and Mark J. Romness, MD, VOS President attended the recent White Coats on Call event on January 22, 2015. |
Thanks to the efforts of VOS, MSV and all of you who have contacted legislators both bills have passed both houses and now await the governor’s signature (at the time of this writing).
We have more work to do. I believe the successful passage of these bills related to prescriptions will allow MSV and VOS to work on reducing the prior approval burdens for MRIs, surgery and other procedures. This will not happen without the continued involvement of all of us. I urge you to continue to educate your legislators about this problem in person and by mail. Stay active with MSV as well as VOS and encourage MSV to continue with this long range plan.
