Reducing the burdens of prior authorization on patients, on physicians and on the health care system is a priority for CMS. Prior authorization leads to care delays and treatment abandonment. Yesterday, legislative champions Rep. Shannon Bird (D), Rep. Lisa Frizell (R), Sen. Dylan Roberts (D) and Sen. Barbara Kirkmeyer (R) – along with 54 other co-sponsors – introduced a bill (HB24-1149) that aims to remove unnecessary burdens to care 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; and 
  • Incentivizing physicians that are consistently providing quality care and referring patients for medically necessary treatments. 

Health plans are opposing the bill and CMS is gearing up for an intense legislative battle. Success in the future hinges active physician engagement and sharing stories that vividly illustrate the direct impact of delayed or denied care due to inappropriate prior authorizations on patients and their families. Share your patient stories here

CMS joins our partners in the Colorado House of Medicine, patient advocacy organizations and many others in applauding the introduction of this commonsense bill to reform prior authorization and calls for its swift passage. Stay tuned for more updates and be ready to respond to action alerts. Review the bill fact sheet here.

Categories: Communications, ASAP