Why It Matters

While prior authorization and step therapy were intended to control medical costs for insurers, they have become a confusing process that can delay access to health care.

Since prior authorization has no approval deadlines under current law, it could take hours, days or weeks to get the vital treatment you need. Patients and doctors find themselves waiting for approval for prescriptions and treatment, meanwhile patients’ conditions worsen or become fatal.

On average, 92% of patients say prior approval has delayed their health care.

Prior authorization and step therapy also are costly to patients. For example, a doctor evaluates a patient with shoulder pain and determines they need surgery to fix it. The insurance company could say the patient needs to try other methods like acupuncture and physical therapy for six weeks to see if the pain lessens or is relieved before they will pay for the surgery. Although the doctor knows surgery is the only fix, the patient must spend time and money going through unnecessary steps before finally getting treated.

No patient should have to jump through hoops to receive the care they need.

We must change the way prior authorization is used to treat patients. We need a commonsense approach that can balance cost and treatment.