States target health insurers' ‘prior authorization' red tape

Summary #

Christopher Marks, a truck driver from Kansas City, Missouri, had to go through a frustrating and time-consuming process known as “prior authorization” in order to get his Type 2 diabetes medication covered by his health insurer. Prior authorization is a tool used by insurers to control costs and ensure appropriate treatment. However, it has faced backlash from patients, medical professionals, and hospitals. The Biden administration has introduced new rules to streamline the process, but many states are considering their own bills to further limit prior authorization requirements. A proposed bill in Missouri aims to establish a “gold carding” program for treatment and prescriptions, exempting providers and facilities that consistently adhere to authorization guidelines. The insurance industry opposes the bill, while organizations representing healthcare professionals support it.