FOR IMMEDIATE RELEASE
DATE: Jan. 31, 2024
CONTACT: Madeleine Schmidt, 405-822-0533

Lawmakers Introduce Bipartisan Prior-Authorization Reform Bill to Protect Patients, Reduce Costs, Ensure Access to Care

HB24-1149 will ensure critical medical decisions are made between patients and providers, because health can’t wait

DENVER, CO – Yesterday, Representative Shannon Bird (D-Westminster) and Representative Lisa Frizell (R-Castle Rock) introduced HB24-1149 to streamline and improve Colorado’s prior-authorization system. This legislation will empower patients and providers to make important medical decisions and reduce the financial costs, patient trauma, and wasted valuable provider hours caused by delayed care.This bill will be sponsored in the Senate by Senator Dylan Roberts (D-Frisco) and Senator Barbara Kirkmeyer (R-Brighton).

“I have heard countless tragic stories from Coloradans in my district who either directly suffered or watched a loved one suffer as a result of delayed care due to prior-authorization issues,” said Representative Bird. “Prior-authorization denials cause dangerous delays in treatment, lack transparency and fairness, create inequitable barriers to health care for vulnerable community members, and put costly time and financial burdens on our health care system. These are risks we don’t have to take, which is why we are introducing this bipartisan legislation.”

“We know that to best ensure timely, efficient and cost effective access to medical care for Colorado patients, decisions should be made between a patient and their provider,” said Representative Frizell. “Insurance carriers should not be practicing medicine, doctors should. Reforms are needed to ensure that all patients, regardless of income or what part of the state they live in, can receive the care they need because health can’t wait."

While doctors have the necessary medical knowledge, training, and relationships with their patients to determine what procedures and medications are best, often physicians must obtain approval from insurance carriers before treating a patient. This prior-authorization process wastes countless essential provider hours on bureaucratic paperwork and often delays essential medical care for patients, increasing medical costs and decreasing positive patient outcomes.

“The truth is denied or delayed care results in more expensive care, and wasting valuable provider time costs us all,” said Senator Roberts. “We also know that women, people of color, Coloradans with disabilities, Coloradans experiencing a mental health issue, and low-income Coloradans are more likely to be denied or experience delayed care. Reforms to our prior authorization system are needed now to reduce health care costs and ensure access to care, particularly in our rural communities already experiencing serious access issues.”

“Unlike insurance carriers, doctors have the direct medical knowledge and relationships with their patients to know what medical treatment is best,” said Senator Kirkmeyer.  “What doctors don’t have in understaffed, overburdened hospitals and physician’s offices is time to fight with carriers over legitimate medical claims to provide access to critical health care for patients. Prior authorization reforms will save money and result in better patient outcomes, and I’m proud to be a part of this bipartisan coalition to fight for meaningful change for Colorado families.” 

Unfortunately, 94% of physicians report delays in patient care due to prior authorization challenges, and 80% have stated that it can result in patients abandoning treatment. Even more disturbing, 25% of doctors reported a delay in care due to a prior authorization issue leading to patient hospitalization, 19% reported a life-threatening event, and 9% reported an event leading to disability, permanent damage, or death.

“My health insurance company forced me to choose between my health and making a house payment when they refused to pay for a diabetes medication I had been on for years,” said Pueblo patient and health advocate Margaret Comstock. “Rather than cover the medication I needed, my insurance told my doctor to increase a different medication I had been taking for my diabetes. That's right – someone working in healthcare claims with no medical training told my doctor what to prescribe.”

In addition to delaying or preventing patient care, on average current prior authorization requirements and appeals processes cost physicians and their staff nearly two full business days per week just to ensure their patients can access their needed medications or health care services. As health care facilities continue to face serious staffing shortages, particularly in rural Colorado, these are critical hours that take away from time with patients and increase stress and burnout levels.

“While physicians have a vested interest in ensuring patients access the treatment they need, some insurance carriers have a vested interest in denying access to that care to protect their bottom line,” said Dr. Omar Mubarak, a vascular surgeon and President of the Colorado Medical Society. “Recent reporting even found that one carrier was using an algorithm that denies claims in mere seconds. At the same time, physicians are spending countless hours dealing with prior authorization challenges, which is precious time away from patient care – especially when we are already experiencing a shortage of healthcare workers.”

HB24-1149 will enact several reforms to help streamline access to treatment for patients and their families and reduce bureaucratic burdens for physicians, including:

  • Preventing disruptions in already approved care, like requiring repeated authorizations for patients taking prescription drugs even after they have already been approved.
  • Ensuring that there is continuity of care by extending prior authorizations to last through the course of treatment.
  • Protecting patients from disruptions in care by ensuring multiple approvals are not needed as additional treatment is required during surgery. 
  • Creating transparency in the system so that patients understand their benefits and likelihood of being approved by requiring formularies to be made publicly available.
  • Incentivizing physicians that are consistently providing quality care and referring patients for medically necessary treatments. 

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