Legislation Aims To Cut Wait for Prescription Drugs

New legislation designed to make the paper trail for prescription drug authorization simpler and shorter is awaiting signature by Gov. Jerry Brown (D).

While it is expected to have little effect on regular issuance of prescriptions, it likely will speed up the process for patients whose doctors prescribe other specialized medicines that are not covered by a health plan’s formulary.

These include brand-name medicines with generic alternatives, expensive medications, drugs not usually covered but deemed medically necessary by the prescribing physician, and drugs that usually are covered but are being used at a dose higher than normal.

Senate Bill 866 by Sen. Ed Hernandez (D-West Covina) is one of about a dozen health-related pieces of legislation that Brown has until Oct. 9 to decide upon. Neither the governor nor officials in his Department of Managed Health Care have expressed on opinion on the proposed law.

It shortens from five days to two business days the time that health insurers have to approve or reject physicians’ pre-authorization prescription requests. It also requires insurers to use a standardized medication authorization form.

The bill’s supporters are confident that standardizing forms and speeding up the authorization process will result in improved patient care.

SB 866 attracted wide ranging support from groups representing physicians and psychiatrists, oncologists and optometrists, pharmacists and mental health professionals, as well as advocates for patients with a number of chronic diseases.   

Among them: Alliance for Patient Access, California Association of  Physician Groups, California Chronic Care Coalition, Mental Health Association of California, Pharmaceutical Research and Manufacturers of America and U.S. Pain Association.

Led by the California Medical Association, supporters said during legislative hearings that current preauthorization policies lead to costly delays and time-consuming efforts that detract from patient care. CMA officials contend that health insurers require that too many different types of forms be filled out and that the problem will get worse as federal health care reforms are implemented.

Opponents argued that the proposed law would clog up the paper trail even further because no standardized form could take into account all clinically relevant information needed by insurers and because follow up faxes and phone calls to physicians would complicate matters.

The California Association of Health Plans, one of the few organizations to oppose SB 866, said the bill was particularly onerous in its requirement that authorization requests are deemed approved if the prescribing physician doesn’t receive an answer within a certain amount of time. Hernandez’s bill originally proposed a 48-hour turn-around time, but that was later amended to two business days.

CAHP is warning that the one-size-fits-all approach doesn’t work in medical care.

“Prescription drug treatments are often uniquely tailored to a person’s specific health care needs,” said Patrick Johnston, CAHP president. “A cookie cutter approach to approvals creates barriers to achieving effective and efficient patient care.  The global nature of standardized forms can stand in the way of customizing prior authorization to ensure the key information for a particular drug is included.  This could lead to extra, unnecessary red tape that ultimately causes delays in getting necessary medicine in the hands of patients.”

Hernandez, an optometrist who serves as chair of the Senate Committee on Health, said he introduced the bill to reduce delays in patient accessibility to medication. He cited an American Medical Association survey released in May 2010 that found 69 % of physicians typically wait several days to receive preauthorization from insurers and that 10 % wait more than a week.

The bill passed the Assembly on a 57-21 vote on Sept. 8 and was approved by the Senate on a 28-11 vote on Sept. 9, the last day of the legislative session.

Under SB 866, the Department of Managed Health Care and the Department of Insurance are to develop a uniform prior authorization form for use beginning Jan. 1, 2013. The new time limit for preauthorization does not apply to Medi-Cal patients because preauthorization for their prescription drugs are already governed by an even stricter turn-around time of 24 hours.