Source: Benefits Pro
A House Republican has proposed a simple way to end complaints about health plan prior authorization programs: eliminate health plan prior authorization programs.
Rep. Jeff Van Drew, R-N.J., has introduced a bill that would ban health plan prior authorization programs.
At press time, the text was not yet available, but the bill would “prohibit group health plans, health insurance issuers, and federal health care programs from applying prior authorization requirements, utilization management techniques, and medical necessity reviews,” according to the bill title.
The bill is the new version of Van Drew’s Doctor Knows Best Act of 2023 bill, which had an identical title.
The earlier bill included a comprehensive ban on prior authorization programs at employer-sponsored health plans.
“A group health plan, and a health insurance issuer offering group or individual health insurance coverage, may not impose any prior authorization requirement, any utilization management technique (including any step therapy or fail-first protocol), or any medical necessity review on any item or service for which benefits are available under such plan or coverage,” according to the bill text.
Health insurers and self-insured health plan administrators use prior authorization programs to tell patients and health care providers whether the plans will pay for the kind of care proposed.
Health care provider groups have complained about slow prior authorization programs and programs that use poorly qualified reviewers to assess care proposals. The American Medical Association has argued that prior authorization programs, including those organized by self-insured employer health plans, hurt physicians’ morale.
Health plan managers have acknowledged that they need to improve how prior authorization programs work, but they contend that well-run prior authorization programs can protect patients against unnecessary, overly expensive or even dangerous care.
What it means: The earlier Van Drew prior authorization bill died in committee, and the odds that the new bill will reach the House floor appear to be low.
But the introduction of the bill shows that skepticism about how health insurance companies and health plans operate crosses party lines.
