HARRISBURG — On the last day of its two-year session, the General Assembly sent a measure drafted by Sen. Kristin Phillips-Hill (R-York) to the governor for his signature that would make significant reforms to prior authorization and step therapy for medical treatment.
The Phillips-Hill legislation would create standards and timely feedback for commercial health insurance plans, as well as Medicaid plans, when health care providers seek pre-approval from insurers. The bill also reforms step therapy protocols.
“It’s been a daunting journey, but in the end, healthcare policy in our Commonwealth has improved dramatically for patients,” Phillips-Hill said. “We received tremendous input and countless hours of stakeholder meetings involving everyone with a vested interest in improving patient health care outcomes in our state. I am grateful that my constituent – Dr. Suzette Song – has brought this issue to my attention so that we can address a problem that healthcare providers face every day that limits their ability to better treat their patients. Today is a big win for health care outcomes in Pennsylvania.
Prior authorization is the process by which health care providers obtain prior approval for payment coverage and reimbursement from an insurer before a specific procedure or service is provided to the patient. The process was originally created to control health care costs for experimental and new procedures. The legislature, through Senate Bill 225, standardized the process and shortened timelines to allow for much faster approval between healthcare providers and insurers.
Step therapy is another form of prior authorization; however, it applies to prescription drug treatment plans. Insurers may recommend different drug treatment options to patients in an effort to reduce costs. Health care providers say this ultimately delays treatment plans and often leads patients to drop out of treatment altogether.
A recent survey of physicians by the American Medical Association found that 78% of physicians said delays in prior authorization can lead their patients to drop out of treatment.
Senate Bill 225 would require insurers to provide timely approval for non-emergency and emergency health care services to physicians before services and treatment plans are rendered. The bill also creates simplified guidelines for step therapy for prescription drugs, as well as new options for patients and their healthcare professionals to obtain an exemption to better treat the patient’s medical condition. .
The same American Medical Association survey also found that 91% of doctors say delays in prior authorization can have negative clinical effects on patients.
“This solves a major problem in our healthcare delivery in Pennsylvania and given the bipartisan support, I hope the Governor will sign the measure to improve the relationship between patients and providers in our Commonwealth,” added Phillips- Hill.
The governor has 10 days to sign, veto, or allow the bill to become law without his signature.
PHOTO CAPTION: Senator Kristin Phillips-Hill (R-York) speaks a meeting of the Senate Banking and Insurance Committee on Senate Bill 225 on June 23, 2021. The committee approved the bill with the understanding that all stakeholders would participate in the conversation to refine the measure throughout the session. The General Assembly gave the final pass to the Phillips-Hill measure on Wednesday after more than a year of work on the issue. The bill heads to Governor Tom Wolf’s office for his signature.
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