Authorization Delays Targeted by Senate Bill

The Senate Committee on Health approved a bill last week that would cap administrative delay at 48 hours for prescription authorization.

The reasoning is simple behind SB 866 by Ed Hernandez (D-West Covina), according to  Liz Helms, chair of the California Chronic Care Coalition.

“In representing more than 16 million people with chronic conditions in California, you can imagine how many medications that these people are taking,” Helms said, “and what a barrage of prior authorizations that face them when they’re trying to get their medication in a timely manner.”

Helms said some of those drugs are life-saving, but because they’re not on health insurers’ formularies, they require prior authorization. And that can sometimes mean a two-week wait, which is a long time to go without vital medication, she said.

“Because of this bill, the streamlining of the prior authorization process and patient care would be immeasurably improved,” Helms said. “And it would mean a much lower cost for everybody.”

Including cost savings for the state of California, said Teresa Stark of the California Medical Association.

“At a time when we are all concerned with controlling health care costs in the system, we think this is a reasonable and sensible way to limit administrative costs while also meeting the needs of patients,” Stark said. “We think it’s a win-win — for providers, for health insurers and, most importantly, for the patients.”

Opposition to SB 866 came from Nicholas Louizos, director of legislative affairs for the California Association of Health Plans. The association logged in as opposed unless amended.

“We do believe prior authorization is very important,” Louizos said. “Our overall concern is this inadvertently puts a process into place that compels coverage of expensive drugs when there are generic or cheaper drugs on the market.”

The Senate health committee approved the bill unanimously, 7-0. It now moves to the Committee on Appropriations.

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