One of the methods that an insurance companies uses to restrict usage of pharmaceutical products is requiring patients to receive prior authorization or prior approval before the company agrees to pay for a particular treatment regimen. These practices can lead to delayed care for patients with chronic conditions and are often incredibly burdensome for treating physicians. For patients living with rare or chronic conditions, like hemophilia and other bleeding disorders, timely access to treatment is a necessity.
Prior authorization, also known as preauthorization, prior approval or precertification, is a reviewing process done by a health insurer to determine whether a treatment plan or prescription drug will be covered by the health insurer. If a patient does not receive prior authorization, and they wish to follow their doctor’s treatment protocol, they must pay for the treatment or procedure out-of-pocket.
HFA supports the standardization of the prior authorization procedure and recommends that legislation includes the following criteria:
- Preauthorization forms can be submitted electronically
- Implement a 48-72 hour time limit to receive a response, if an insurer does not respond within that time period, the prior authorization is automatically approved
- Lengthen the preapproval process for medication to last for a minimum of 180 days
- Shorten and standardized prior authorization forms
For more information, click here to read our issue brief.