Oklahoma SB 756: Prior Authorization Reform
Heartland Impact supports a yes vote on this bill
WHAT THIS BILL DOES
When a less expensive drug is available and comparable to a more expensive one, corporations and government purchasers have developed policies that force the patient to try the cheaper drug first by requiring prior authorization (PA) to skip to a more expensive alternative. This has pulled cost out of the system, but also has delayed appropriate treatment for patients and wrapped providers in red tape.
In Oklahoma, Sen. Jessica Garvin has introduced SB 756, which would streamline this process by allowing some providers in the state Medicaid program to skip the prior authorization process. This “gold card” status would provide an exception to the PA process to providers who “would have been approved for not less than 90% of the prior authorization requests by the provider for the particular healthcare service.”
OPPOSITION TO THE BILL
Critics of this bill want to keep prior authorization mandatory to save costs. However, the ‘gold card’ system proposed in this bill would only grand prior authorization exception to providers who’s record indicates that nearly all of their prior authorization requests have been approved. This means that the providers able to skip prior authorization protocols likely would have those requests approved, so the cost remains relatively unchanged, and the patient is able to receive the care they need more quickly.
WHY THIS BILL SHOULD PASS
This bill will allow patients to get the best care possible in a more timely manner by giving the decision making power to trusted providers rather than bureaucratic processes.
Current Medicaid reimbursement is 72 cents on-the-dollar when compared to private health payers. Sen. Garvin’s bill would make it less burdensome for providers to see Medicaid patients. Physicians and other providers who already face a daunting thicket of regulations and reduced payments can be easily dissuaded from seeing Medicaid patients entirely if those reduced payments are rejected entirely because the gatekeepers were unsatisfied. Consequently, exemptions to PA are welcomed by doctors forced to repeatedly beg permission for the appropriate medication.
- Patients will receive care sooner, and will be less likely to abandon seeking care due to time and hurdles.
- Providers will be able to focus more on patient care and less on jumping through bureaucratic hoops.
- The prior authorization system will still be in place where it is needed. The ‘gold card’ system will only allow providers who regularly have their prior authorization requests approved to skip the process.
WHAT IT COSTS
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Heartland Impact can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Cameron Sholty, at csholty@heartlandimpact.org or 312/377- 4000.
OTHER RESOURCES
Bills in 30 states show momentum to fix prior authorization https://www.ama-assn.org/practice-management/prior-authorization/bills-30-states-show-momentum-fix-prior-authorization The American Medical Association reviews Prior Authorization Legislation in the States
CMS Prior authorization proposal aims to streamline the process and improve transparency
The Kaiser Foundation examines the proposed federal action to improve patient care through PA reform.
Could Texas Law on Limiting Prior Authorization Delays Move the Needle Nationwide? https://www.medpagetoday.com/special-reports/exclusives/94625 Jennifer Henderson from MedPage looks at how the “gold card” is the first step in helping physicians with the burdensome process of prior authorization.
Measuring the Scope of Prior Authorization Policies https://jamanetwork.com/journals/jama-health-forum/fullarticle/2780396 JAMA details procedures that require prior authorization and how that impacts delivery
Will Prescriber “Gold Cards” Solve the Prior Authorization Problem?
The Accreditation Council for Medical Affairs reviews “Gold Card” statutes as a means of reforming PA
Why Prior Authorization is Bad for Patients and Business https://www.ama-assn.org/practice-management/prior-authorization/why-prior-authorization-bad-patients-and-bad-business Andis Robeznieks from the American Medical Association outlines what’s wrong with prior authorization
