Potentially life-saving prior authorization, step therapy bill moves out of Pa. Senate Committee

Pennsylvania

HARRISBURG, Pa. (WHTM) — A potentially life-saving bill that would let doctors prescribe medicines without being stalled or stopped by insurance companies is making headway. The State Senate’s Banking and Insurance Committee unanimously passed Senate Bill 225.

It was in committee for a few months, as advocates hosted an event encouraging lawmakers to take action.

The bill takes some power from health insurers and gives it back to doctors by putting an end to restrictive prior authorization and step therapy.

Prior authorization makes prescribers get approval from insurers before giving medicine or moving forward with specific treatments.

Patient advocates say it forces people with debilitating diseases to wait for what could be life-saving relief.

Step therapy requires patients to try, and fail, one or more medications, tests, or treatments chosen by their insurance company before getting what was actually recommended by their doctor.

“I currently have a patient who has all of the signs and symptoms of having a mass in his pituitary gland in his head and it took five doctors to get the authorization from his insurance company,” said Dr. Tiffany Leonard, the president of the Pennsylvania Academy of Family Physicians. “It was not until we got him in front of a neurosurgeon that it was finally approved.”

The American Medical Association says 78% of patients report prior authorization delays lead them to abandon their treatment, and 92% of doctors report prior authorization delays can have a negative clinical impact on patients.

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