Health Plan as Gatekeeper to Personalized Care

When a patient’s health insurance influences the care he or she receives more than the patient’s own physician, does the patient get real-time access to the best treatment for their condition in the most appropriate care delivery setting? Does an administrative middleman at a health plan who has never actually placed hands on the patient, evaluated lab and imaging test results, or studied a patient’s unique medical history really know best the course of treatment for that patient? Patients, providers and caregivers respond passionately ‘NO!” When prior authorization processes are deliberately difficult and driven by cost containment goals rather than concern for patients, priorities are dangerously off-track.

The American Society of Clinical Oncology has highlighted research funded by the National Institutes of Health that found nearly “three-quarters (72.3%) of oral anticancer drug prescriptions required a prior authorization.” A closer look at how prior authorization impacted patient care revealed “a quarter of patients (25%) waiting more than 14 days for their medication, and 5% waiting more than 30 days.” Patients, especially those with complex chronic conditions, their caregivers and medical team know first-hand the disruption caused by prior authorization.

Patients and Providers United amplifies the voices that seek to keep patients and providers at the center of medical decision making, because prior authorization policies should never enable bureaucratic middlemen to interfere with the carefully crafted, individualized treatment plans physicians develop for their patients.