What began as a safeguard against unnecessary drug spending has become a significant barrier to patient access. And as “Understanding Prior Authorization,” a new video from the Alliance for Patient Access, explains, the process may cut costs at patients’ expense.
Prior authorization occurs when an insurance company must approve a patient’s prescription before it will agree to cover the drug. All types of treatment can be subject to prior authorization, but it is frequently used to restrict access to costly and innovative therapies like biologics.
Prior authorization processes can be unwieldly, the video explains, requiring doctors and their staff to spend excessive amounts of time filling out forms, submitting records, and communicating back and forth with insurance representatives. The insurance company’s review can take days, even longer in the case of denials and appeals.
While the process ensues, patients must wait – even those with chronic conditions who require continued treatment. This may place patients at risk or introduce additional health issues. Patients can become frustrated and even give up on their treatment.
In several states, lawmakers have introduced legislation that would put commonsense limits on the use of prior authorization. These efforts, the video notes, could protect patients’ access and help restore physicians’ ability to make personalized decisions about care.
To learn more, watch “Understanding Prior Authorization.”