Nov. 14, 2019: State Advocacy Update

. 3 MIN READ

Last week, Michigan lawmakers introduced Senate Bill (S.B.) 612, legislation to reform the prior authorization and step therapy processes. The legislation addresses critical problems with these common utilization management programs including the lack of transparency and clinical validity in the requirements, as well as the delays in care that often have serious consequences for patients.

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Nationally, there continues to be every indication that prior authorization requirements are increasing and expanding. Physicians are troubled and frustrated by the overstepping of insurers into the clinical decision-making process and with the time, money and energy spent on ensuring their patients can access covered drugs and services. The AMA released its Prior Authorization Physician Survey earlier this year, and of the practicing physicians surveyed, over 90 percent report care delays associated with prior authorization. But most concerning is that 28 percent of respondents reported that prior authorization has led to a serious adverse event for their patients.

Recognizing the harmful impact of these prior authorization programs, the Michigan State Medical Society helped form a broad coalition of stakeholders, including patients, physicians and other providers. The Health Can't Wait coalition is working to educate lawmakers and the public about the need for immediate reform through meetings, action alerts, news conferences, story sharing and even mobile billboards.

For more information on this coalition visit www.healthcantwait.org or follow them on Twitter.

And for more information about the AMA's efforts on prior authorization or to share your story about prior authorization, visit www.fixpriorauth.org.

For the second year in a row, more than 90% of pain medicine specialists said that they have been subject to prior authorization (PA) barriers when trying to provide non-opioid pain care for their patients. The findings come from a recent survey by the American Board of Pain Medicine (ABPM) (PDF). Prior authorization was common for treatments ranging from physical therapy, pain creams and patches, non-opioid medications and non-opioid pain treatments such as TENS, facet blocks and spinal cord stimulation.

"Prior authorization in some cases may be understandable to help ensure coverage benefits or coordinate complex care, but when it is used almost universally like this, it seems that the real purpose is to discourage physicians and patients from seeking non-opioid pain care," said Mitchell J. Cohen, MD, ABPM President.

The survey also found that 72% of pain medicine specialists said that they—or their patients—have been required to reduce the quantity or dose of medication prescribed, a reduction from the 83% forced to do this as reported by the 2018 ABPM survey. The effects of the reductions have included withdrawal, anxiety and depression as well as suffering with increased pain.

The ABPM also found the effect on physicians' practices equally severe with two-thirds of survey respondents saying that they have had to hire additional staff just to handle prior authorization requirements.

For more information, please contact The ABPM's Mike Slawny at [email protected]

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