Advocacy Update

July 25, 2019: State Advocacy Update


Jack Resneck, MD, Immediate Past Chair, AMA Board of Trustees, last week presented the AMA's position and state legislative priorities on prior authorization during a special health care session at the National Council of Insurance Legislators' (NCOIL) summer meeting. Dr. Resneck, a practicing dermatologist, started the session with an overview of why prior authorization reform is needed using data (PDF) to illustrate the burden on patients and physicians, as well as personal experiences from his practice where prior authorization delays on even inexpensive medications have resulted in harm to his patients and practice.

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Dr. Resneck highlighted AMA resources including and expressed disappointment with insurers' efforts to realize the prior authorization reform goals outlined in a multi-stakeholder consensus statement (PDF). He then detailed the AMA's recently revised prior authorization model state legislation and called on NCOIL members to support prior authorization and step therapy reforms in their states.

A representative from the Blue Cross Blue Shield Association attempted to frame prior authorization as a medical management tool that promotes patient safety and directs physicians to lower-cost treatments. The representative suggested more back-office staff is needed to reduce the prior authorization burden and, without citing sources, that physicians are often not practicing evidence-based medicine as a justification for prior authorization.

Benjamin Chandhok, Senior Director of State Legislative Affairs at the Arthritis Foundation, presented a report on the impact from the patient perspective, drilling down on irreversible harm that can result when medication is delayed or switched. He called for legislators to act now on at least the "low-hanging fruit" outlined in the prior authorization reform principles (e.g. transparency, notification) to improve the situation for patients.

For more information on the AMA's model legislation or state legislative efforts on prior authorization, please email Emily Carroll at [email protected].