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Improve transparency and clearly articulate PA criteria, rationale
and program changes. But 69 percent of physicians reported it was
difficult to determine which medications or services required PA.

"There is no reason for insurers to use prior authorization for
medications to treat opioid-use disorders when patients' lives hang
in the balance," said Dr. McAneny.

Protect continuity of patient care by ensuring continued access
to effective treatment during health plan or coverage changes and
eliminating repetitive PA requirements. Surveyed physicians indicated
that this is not happening, as 85 percent report that PA interferes
with continuity of care.

Larger PA reform legislation is also being considered by state
legislatures this year. States such as Kentucky, Colorado, Maine and
Virginia are among those with bills to reduce delays in care as a result
of PA and to increase the transparency of PA programs.

Accelerate use of automation in PA processing. Despite health
plan commitment to utilization of standard electronic transactions
for PA, physicians report that phone and fax are still the most common methods for completing PAs. Additionally, only 21 percent of
physicians report that their electronic health record system offers
electronic PA for prescription medications, despite an existing
standard process.
A rare example of progress involves removing delays in treating
opioid-use disorder (OUD). In Pennsylvania, for example, insurance
companies agreed to remove PA requirements for medication-assisted
treatment to help people with OUD. Bills mandating similar action
have been introduced in the Kentucky and Vermont legislatures. The
AMA is working to get other states to remove PA barriers to treatment.

The AMA has also advocated extensively with federal regulators
to oppose increased use of PA and other utilization management
programs in Medicare programs. In September 2018, the AMA and
over 90 other state medical associations and national medical specialty
societies wrote the Centers for Medicare and Medicaid Services (CMS)
objecting to a policy change that permits the use of step therapy for
drugs covered under Part B in Medicare Advantage plans. The AMA
also submitted comments objecting to a planned expansion of PA
and step therapy use in Medicare Part D and Medicare Advantage
plans. Finally, the AMA recently partnered with state and specialty
medical organizations in a sign-on letter urging CMS to provide
strong guidance on use of PA in MA plans in its 2020 Call Letter.
The AMA invites patients to share their experiences with PA and
to sign a petition urging reform at FixPriorAuth.org.

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SPRING 2019 | CHESTER COUNT Y Medicine 17

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ChesterCountyMedicineSpring2019

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