HARRISBURG, Pa. – On May 5, state Rep. Steven Mentzer (R, Lancaster) and patient advocates from across Pennsylvania will host a virtual press conference to encourage legislators to prioritize HB 1194 (SB 920). If passed, the bill would curb restrictive prior authorization and step therapy (fail first) practices imposed by health insurers.
Amid the COVID-19 pandemic, many states and insurers have temporarily lifted these restrictions in an effort to provide greater access to care. However, patient advocates are warning the issue goes much deeper than our present environment.
Prior authorization and step therapy are often applied to patients living with a wide range of diseases and chronic conditions, like, cancer, diabetes, HIV/AIDS, heart disease, arthritis, and multiple sclerosis.
A practice that started as a method to control costs for experimental or new procedures, prior authorization requires physicians to obtain approval from insurers before prescribing medication or moving forward with a specific treatment. Step therapy requires patients to try, and fail, on one or more prescription drug, test, or treatment option chosen by their insurance company before gaining access to the drug, test, or treatment option that was recommended by their physician.
“We must consider long term solutions for the delays that can be caused by prior authorization and step therapy, not just a temporary fix. If these practices can be curbed for COVID-19, they should be restricted for all treatments,” said Faye Parker, cancer survivor and volunteer for the American Cancer Society Cancer Action Network—ACS CAN. “Cancer patients such as myself are already fighting for our lives. We cannot afford to wait on insurers to approve tests or treatments ordered by doctors. Those delays can cost us precious, life-saving time.”
According to a recent survey of physicians by the American Medical Association, the negative impact of processing prior authorization requests on patients is clear. A staggering 78% of patients report prior authorization delays can lead to them abandoning their treatment. And 92% of doctors report prior authorization delays can have a negative clinical impact on patients.
Schedule for Event:
- Rep. Steven Mentzer, District 97, Republican, Lancaster County
- Faye Parker, Reading, PA, ACS CAN Advocate
- Kerry Ferraro, Lower Gwynedd, PA, Arthritis Foundation Advocate
- Keisha Hester, Erie, PA, National Multiple Sclerosis Society Advocate
Event supported by:
The Coalition to Improve Prior Authorization and Step Therapy for Pennsylvanians
ACS CAN is making cancer a top priority for public officials and candidates at the federal, state, and local levels. ACS CAN empowers advocates across the country to make their voices heard and influence evidence-based public policy change as well as legislative and regulatory solutions that will reduce the cancer burden. As the American Cancer Society’s nonprofit, nonpartisan advocacy affiliate, ACS CAN is critical to the fight for a world without cancer. For more information please visit www.fightcancer.org.