Join HFM and Health Can’t Wait at an important legislative hearing on January 30, 2020. Click here to register.
Health insurers are increasingly requiring patients and providers to move through many different prior authorization and step therapy processes before covering treatment and/or procedures.
- Prior authorization (PA): a requirement that your health care provider obtain approval from your health insurance before the provider can prescribe a specific medication or procedure.
- Step therapy: often called “fail first,” step therapy is a process used by health insurance companies that requires patients to try some (generally less expensive) drug, before they cover other (generally more expensive) drugs that treat your condition.
Prior authorization and step therapy requirements are time-consuming and often delay access to physician-prescribed treatment. For bleeding disorders patients, a delay in care is serious and can be life threatening. Lengthy prior authorization processes not only harm patients, but add more administrative work for physicians, leading to less time spent with patients.
Patients and providers from across disease states have recognized the serious consequences of these policies and have joined forces to reform prior authorization and step therapy in Michigan through Health Can’t Wait (HCW). HCW is “a coalition of patients, health care providers, and associations dedicated to putting Michigan patients first and ending delays in patients’ access to health care.” The coalition has worked closely with State Senator Curt VanderWall to draft legislation that would reform prior authorization and step therapy.
The draft legislation ensures that:
• PA requirements are easily understandable and accessible to physicians, providers, and patients.
• Adverse determinations and appeals must be made by an expert reviewer who is a physician/provider in the specialty of the service in question.
• Step therapy protocols can be overridden if a physician determines it is in the best interest of the patient.
• Urgent PA requests be acted upon within 24 hours of submission.
• Standard PA requests be acted upon within 48 hours of submission.
On January 30, 2020, the Senate Health Policy Committee is holding a hearing in Lansing to discuss the Health Can’t Wait bill, Senate Bill 612, and hear testimony from patients and providers. The bleeding disorders community will be attending the hearing at 1pm to show our support for the legislation.
Will you join us?