An issue that is negatively impacting patients with bleeding disorders across the state of North Carolina is the burdensome process of prior authorization. Prior authorization is a cost-containment process implemented by health insurers to determine whether they will approve coverage for a treatment plan or prescription drug. The current prior authorization process erodes a patient’s ability to receive quality and timely treatment by creating access to care problems. The American Medical Association believes prior authorization requests are overused processes that present significant administrative and clinical concerns.
Insurers now commonly require repeat prior authorization for most expensive medicines, and even for generic medications with no cheaper or more effective alternatives. Bleeding disorders medications are high-cost treatments with no alternatives. Requiring this medication to be pre-approved multiple times a year, through a lengthy and arcane process, creates unnecessary burdens for doctors and causes unnecessary delays for patients. Persons with bleeding disorders cannot afford the disruptions to care that the current prior authorization process often creates because any type of delay of care means risking more bleeds, permanent joint damage, hospitalization, and even death.
- Plain language in review requirements
- Requires insurers discuss with a physician of that speciality before denying a treatment
- Timely decisions
- Review and appeal standards
- Continuity of care from previous insurers
- Limits on retrospective denials