Doctors Are Fighting to Give Patients the Right Medicine at the Right Time

The House Small Business Committee heard recently from physicians about how utilization management techniques like prior authorization snarl patient care, smother physician decision making under layers of red tape, divert resources from patient treatment and do not produce better outcomes. Prior authorization is a process by health insurance plans that requires a physician to first obtain approval before conducting a procedure or prescribing a medication. This hearing shed light on how these insurance rules impact patient care.

To provide care for their patients, prior authorization forces many physicians to spend their time pleading with insurance companies and pharmacy benefit managers instead of in exam rooms treating patients. This delays care and obstructs thoughtfully crafted treatment plans. In fact, a family physician from Alaska told the Committee that he used to see 25 patients each day but that has fallen to 15 as a result of the time he spends seeking authorization for care from insurance plans. The radiation oncologist at the hearing testified that 9 out of 10 of his colleagues have had their patients’ care delayed by prior authorization rules. All of the physicians at the hearing unanimously agreed that delays in care contribute to inferior outcomes.

Legislation has been introduced that would streamline prior authorization so doctors can do what they have been trained to do, care for patients. The Improving Seniors’ Access to Timely Care Act, H.R. 3107, has been endorsed by over 370 patient and provider organizations. Putting a middleman, with no clinical experience in the medical decision making chain undoubtedly disrupts the personalized treatment plans that physicians carefully develop for each patient, restricts real-time decision making by doctors and hasn’t been shown to generate any cost savings for patients. Patients and Providers United amplifies the voices that seek to keep patients and providers at the center of medical decision making by telling policymakers Don’t Complicate My Care!