Put patients first with prior authorization reform


Imagine you are a cancer patient and your physician prescribes a medication with the potential to improve your condition or even save your life. Now imagine you must wait two to three agonizing weeks to begin the treatment because your insurance provider demands you receive prior authorization before they’ll cover it. As you wait for their response, your pain continues and your condition worsens.

Unfortunately, this is not just a hypothetical situation. All too often, healthcare providers receive letters from insurers demanding that treatments receive prior authorization. Each time a provider receives a letter like this, it is followed by a sinking feeling, knowing a patient will be forced to wait for potentially life-saving care.


Recently, a major health insurer’s medical director made it clear that prior authorizations have little to do with improving patient health when he admitted under oath that he never looked at patients’ records when deciding whether to approve or deny care. This stunning admission should be a call to action to ensure our health care system is prioritizing patient wellbeing over costs. Providers, not insurance companies, should be the ones making medical decisions.


Surprisingly, eight out of ten prior authorization requests are ultimately approved. This statistic raises an important question: Are these delays to patient care really necessary? We don’t think so.

That’s why we’ve introduced legislation in the General Assembly to reform prior authorization requirements with people, not insurance companies, in mind. We’ve seen far too many patients suffer at the hands of these confusing and needless requirements and it is time for change.

In addition to impeding patient care, prior authorization requirements add burdensome red tape to a health care system that’s already lacking time, resources and money. It’s estimated that for every physician, prior authorizations take up 20 hours per week and cost $82,975 per year. All this extra red tape pulls them away from what should be their primary role: treating patients.

There’s no question reform is needed. The prior authorization process must be streamlined so patient care is no longer compromised.

Despite major innovations in technology, prior authorization systems still rely on antiquated paper forms, faxes and automatic telephone systems. Transitioning a more efficient electronic prior authorization system is long overdue. Senate Bill 143 will ensure providers have access to these systems, slashing wait times for prior authorization approvals and reducing health care costs.

Another simple reform included in Senate Bill 143 is the establishment of a minimum approval duration period. This will improve medication adherence and patient care by ensuring prior authorization approvals are valid for a least one year.

There is no shortage of complex issues facing our health care system. Streamlining the prior authorization process to better serve patients and providers is a commonsense solution to one of the biggest problems plaguing our industry today.

Several states, including our neighbors in Ohio, have already passed legislation to reform prior authorization requirements and improve patient care. It’s time for Kentucky to pass Senate Bill 143 and do the same.

-Senator Ralph Alvarado is the bill sponsor for Senate Bill 143. He practices medicine in Lexington, Ky.  Representative Kim Moser serves as the NKY Director for the office of Drug Control Policy.