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Resolution to Improve Upon the Current Prior-Authorization Law in the State of Virginia (PDF)

Submitted by Richmond Academy of Medicine

WHEREAS, prescription prior-authorization requires health care providers to go through many extra
steps to obtain an insurers approval prior to prescribing medications, and

WHEREAS, prior-Authorization requires hours of uncompensated physician and staff work, and

WHEREAS, prior-Authorizations continues to be unnecessary and constitutes an undue burden; and

WHEREAS, private offices and hospitals employ numerous people to cope with the added burdens of
required prescription prior-authorizations adding to overall health care costs, and

WHEREAS, a 2014 article in the “Journal of the American Board of Family Medicine” estimated that
insurers’ prior-authorization practices currently costs the nation’s entire health-care
system between $23 billion to $31 billion a year, and

WHEREAS, in 2015 the Governor signed a bill which was meant to improve transparency, uniformity
and efficiency in the current prescription prior authorization process, and

WHEREAS, despite the current law existing, insurers still drag their collective feet when physicians try
to settle prior authorization matters in a timely way for their patients, and

WHEREAS, the current prior-authorization appeals process is arduous and oft impossible with the
following common practices occurring:
• Many appeals (unless “urgent”) take months to get a decision because most health
plans don’t acknowledge receipt of appeal and often claim to not have received the
appeal even though a fax confirmation exists;
• Initial authorization requests are directed through an off-shore call center slowing
down the authorization because of language barriers.
• Some health plans require a written authorization from the patient in order to do an
appeal, which is often required for medical services as well which slows down the
process
• When trying to get a drug authorized that is non-formulary, the health plan isn’t
required to do a tier exception and the costs of the drug can be outrageous.
• Generic drugs can be as expensive or more expensive than some brand name drugs
• Health plans are requiring physicians to go through the prior authorization process to
screen for contraindications, not trusting that the physician (and the pharmacy) is
properly screening the patient; and

WHEREAS, the Medical Society of Virginia has been committed to this issue, successfully helping to
pass the 2015 prior authorization bill in the 2015 General Assembly Session, therefore be
it

RESOLVED, that the Medical Society of Virginia continue to work with Insurers and request they be
more open and transparent about their approval (and rejection) processes and demand
that they release information identifying the common evidence-based parameters for
insurers’ approval of the 10 most frequently prescribed chronic disease management
prescription drugs, as required by the 2015 law, and be it further

RESOLVED, that the Medical Society of Virginia, work with the General Assembly to push insurance
companies to upgrade the electronic approval of prescription requests, which has been
shown to bring cost savings in other states within a few years of its implementation, and
be it further
RESOLVED, that the Medical Society of Virginia join the American Medical Association to aid in priorauthorization reform with a goal of building a dialogue between providers, health plans
and their third parties to cut out needless administrative waste from the system.
 

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Comments

Well stated.  Let's keep turning the pressure up.  This issue has significant negative impact on patients and medical practices on a daily basis.

Mitchell B. Miller, MD