Prior Authorization Becomes Law in KY

Governor Bevin signs law on March 26, 2019

Imagine you’re diagnosed with a chronic condition like rheumatoid arthritis, which rocks your world and changes life as you have known it. With the help of a good physician, you develop a treatment plan that will hopefully improve your condition and make the tasks of daily life manageable.

However, your shock comes when you learn it may take weeks to get approval by your insurance company for your treatment plan to go into effect. The chance looms that you may not get covered. Permanent joint damage can occur while you’re waiting. Patients ask: Who is determining my health care needs? If you have experienced prior authorization, you know how frustrating it can be.

Angela Young experienced the delay of prior authorization firsthand.

“My physician decided the biologic medication I was on was not working. It took over six weeks before a new biologic was approved. Since we had already stopped the first biologic, I was not on any medication for a long period. The pain level required I return to prednisone, which causes other issues, such as weight gain, thinning of bones, interrupted sleep and higher blood glucose levels. I ended up needing a painful procedure to reduce the buildup of fluid in my knee. I can’t help but think if I had gotten the new medication approved sooner, I would have been able to avoid this painful procedure.”

The exciting news is that — with the passage of SB 54, legislation sponsored by Sen. (and physician) Ralph Alvarado — the delays in care should become the exception, not the rule, as barriers are removed.

Beginning Jan. 1, 2020, patients and providers will receive responses on their prior authorization within 24 hours for urgent care and five days for nonurgent services. No longer should delays take weeks to resolve, as in the past. For maintenance drugs, the prescription will only need one prior authorization a year, even if dosages change during the coverage period. Ultimately, patients will be able to implement their doctor-prescribed treatment plan more efficiently.

The Arthritis Foundation’s Kentucky State Advocacy Chair Cheryl Suhr sums it up: “In the long run, this bill will reduce costs for everyone and minimize pain and permanent damage to the body. Eliminating the waiting time patients can get on the appropriate drug will also minimize the cost of unnecessary procedures, which would have to be covered by the insurance agency.”

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