Fix Prior Authorization

Two different bills have been introduced in the Minnesota legislature to address prior authorization by putting safeguards for patients on mid-year formulary switching and creating transparency and time limits to the prior authorization requirements and process.

Read on to learn more about this legislation, and take action by contacting your legislators.

Prior Authorization Reform Bills

Legislation has been introduced in both bodies to better ensure that patients can receive pharmaceuticals, medical procedures and services, and diagnostic testing without undue interference from third-party payers.

The bills (HF3398, SF3204; HF1257, SF1006) are authored by Senator Julie Rosen (R – Vernon Center) and Representative Kelly Morrison, MD (DFL – Deephaven), and include an impressive group of bipartisan coauthors.

The proposals have many important patient protections as well as measures to reduce the administrative burden of prior authorization. Among the dozens of provisions, several notable pieces include:

  • Prior authorization determinations will be made in 36 hours (instead of 10 business days).
  • The appeal process will be streamlined to one process and a decision must be made within 72 hours (instead of up to 30 business days).
  • If a patient changes health insurance plans, the new plan will cover existing prior authorizations from the previous plan for 60 days to allow for a safer transition to a new treatment.
  • A health insurance plan will not be able to change coverage terms or clinical criteria during the plan year.
  • Health insurers will not be able to deny or limit coverage of a service that a patient has already received solely based on lack of prior authorization or a second opinion, to the extent that the service would otherwise have been covered had prior authorization been obtained.
  • A physician who has experience treating patients with the illness, injury or disease for which the health care service has been requested will determine prior authorization.
  • Health plans will post on their public website prior authorization requirements and restrictions in detailed and easily understandable language.

Addressing medication interference is a legislative priority for the Minnesota Academy of Family Physicians (MAFP), and we are joining the Minnesota Medical Association, Minnesota Hospital Association, Minnesota Association of Ambulatory Surgery Centers, Minnesota Medical Group Managers Association, Center for Diagnostic Imaging and dozens of individual clinics to push this legislation.

MAFP President Renée Crichlow, MD, will be testifying at the Capitol on February 27, 2020, asking legislators to protect patients from mid-year formularly changes.

Take Action

Use this online tool to email your representatives, and tell them to protection patient care by fixing prior authorization. The body of the email will be populated for you, but you will have the ability to edit the text to include examples of your own experiences with prior authorizations.

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Authors:

  • Dave Renner, CAE, legislative rep, @daverenner
  • Jami Burbidge, MAM, director of advocacy & engagement, @jami_burbidge
  • Emie Buege, communications

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