10 states have so far dealt with pre-approval in 2024
State legislatures have had a lot of work to do this year when it comes to restricting insurers’ use of prior authorizations.
Since January, nearly a dozen states have passed legislation vehemently pushed by state medical boards and the AMA aimed at reducing the delays in care and wasted time that patients and doctors experience due to out-of-control authorization requirements.
The details of the laws vary from state to state, but broadly they aim to reduce the growing number of authorization requirements, reduce delays in patient care, publicly disclose more data and improve transparency about which drugs and procedures require authorization.
Vermont, Minnesota, Wyoming, Colorado, Illinois, Mississippi, Maine, Maryland, Oklahoma and Virginia passed prior authorization laws this year that include one or more of these topics after state medical societies pushed for changes. The AMA supported the states with resources such as model laws, legislative analyses and more.
More states may pass legislation this year, including Massachusetts. State lawmakers are considering a bill that would require a patient’s new insurance company to honor the previous authorization for prescription drugs from the previous insurance company for at least 90 days after the patient enrolls. In addition, authorization for drugs and treatments prescribed to treat chronic diseases would have to remain valid for the duration of the prescription, which is up to 12 months.
The state’s success and continued movement on prior authorization bills come after the District of Columbia and nine states passed prior authorization reform laws last year.
The AMA is addressing the prior authorization issue by urging insurance companies to prevent treatment delays, patient harm, and practice inconveniences.
Minnesota changes approach
Minnesota changes approach
Minnesota passed a strict prior authorization law in 2020 to reduce response times, ensure that physicians are involved in decision-making, and increase transparency. Minnesota law already included language stating that prior authorization could not be required for emergency services.
But people at the Minnesota Medical Association heard that prior authorization is getting worse for the state’s patients and doctors, as more and more procedures require prior authorization and the requirements themselves become more complex. Emergency medicine is one area where state law already prohibits prior authorization.
“We looked at the law and said, OK, what else do we want to add? We focused on the services where any delay is a problem,” said Dave Renner, director of advocacy for the Minnesota Medical Association. “It’s a different approach to say, let’s try to reduce the frequency of using prior authorizations.”
Finally, Minnesota has passed a law that prevents the use of prior authorization for the non-drug portions of cancer treatment and mental health care. If you have a chronic condition, the prior authorization does not expire as long as the treatment does not change. So a person with type 2 diabetes or rheumatoid arthritis does not need to get prior authorization every six months or every year. The exceptions are set to take effect in January 2026.
All insurers and utilization review organizations must report annually to the state health department on how often they use prior authorization and how often they approve or deny claims. The previous law required insurance companies to post the data on their own websites, which some companies did better than others.
“This will standardize the data and allow it to be analyzed,” Renner said. “We will better understand how and when prior authorizations are used and whether it makes sense. For example, why do we require prior authorization for services that are approved 98% of the time? Does this result in a delay in patient care?”
The AMA advocates for important reforms at the state and federal level that must be implemented to improve prior authorization, including gold carding programs, making prior authorization valid for the duration of treatment for patients with chronic conditions, and requiring new health plans to honor a prior payer’s prior authorization for at least 90 days.
The aim of the states is to protect patients
The aim of the states is to protect patients
In states across the country, lawmakers are making a concerted effort to reduce prior authorization burdens, with more than 90 percent of physicians reporting that prior authorizations lead to delays in care, according to the AMA’s annual nationwide survey of 1,000 practicing physicians.
In Vermont, Governor Phil Scott signed a law that would not require chronic disease patients to continually obtain new prior authorizations for unchanged treatments and would require insurers to respond to urgent prior authorization requests within 24 hours. The Vermont measure also requires a new insurer to accept a previous health insurer’s prior authorization for up to 90 days. The law requires doctors and health insurers to report to the legislature on the law’s impact.
In the US state of Wyoming, lawmakers have passed a law that, among other things, establishes a “Gold Card” program that exempts doctors from the need for prior authorization if they have received regular authorizations for certain procedures or medications in the past. It also requires a longer validity period for prior authorizations for patients with chronic conditions.
The Wyoming measure also requires insurers to respond to prior authorization requests more quickly — within 72 hours for emergency cases and five calendar days for non-emergency cases. It also provides a grace period within which insurers must honor prior authorizations if the patient changes insurers.
At the national level, the AMA also strongly supports the Improving Seniors’ Timely Access to Care Act of 2024, a bipartisan and bicameral federal bill that would reform Medicare Advantage authorization processes.
