Bill Introduced to Reform Prior Authorization Process

A bill to reform the prior authorization process in Pennsylvania ― strongly supported by the Pennsylvania Medical Society (PAMED) ― was introduced by State Rep. Marguerite Quinn (R-Bucks) on Feb. 9, 2016. She announced the bill’s introduction during her discussion with PAMED’s Specialty Leadership Cabinet that same day.

As you know, health plans require prior authorization for certain medical tests and procedures before they are administered for those services to qualify for insurance coverage. While the process is intended to minimize the overuse of health care services, it often becomes extremely burdensome due to a lack of standardization and transparency in prior authorization requirements.

HB 1657 would:

  • Increase transparency and consistency in prior authorization criteria
  • Establish standards for and reduce the overuse of prior authorization
  • Lessen manual processes and enhance the electronic exchange of information
  • Develop a standard prior authorization form
  • Improve response times for prior authorization determinations

““I’ve met with my physician constituents on this issue,”
Rep. Quinn said. “In the coming months, my colleagues in the House need to hear from their local physicians and more importantly, from patients whose care has been negatively affected by the prior authorization process.””

If you have stories to share on this issue regarding how the prior authorization process has impacted you and/or your patients, please email Hannah Walsh, PAMED’s associate director of legislative affairs.

“I’m happy to be working with PAMED on this issue,” said Rep. Quinn, adding that she believed her legislation will serve to streamline the prior authorization process for physicians, their patients, and insurance companies.