Providers Speak Out
Prior authorization barriers create obstacles in the ability of vulnerable seniors and disabled beneficiaries to access medicines, resulting in treatment delays that can have deadly consequences.
Part B Access for Seniors and Physicians Coalition
PRIOR ATHORIZATION
Prior Authorization places a middleman at a health plan in the center of medical treatment decision making. A health plan administrator who has never actually placed hands on the patient, evaluated lab and imaging test results, or studied a patient’s unique medical history must approve treatment and care prescribed by a physician before that care can be delivered. This delays patient care and discredits medical specialists’ expertise, experience and extensive training.
Physicians lean heavily on their medical expertise and years of training when confronting challenges that require them to ‘think outside the box’ for their patients. In some cases, this might mean highly specialized combinations of drugs or using a well-known therapy in a novel manner. Unfortunately, insurance plans often balk at coverage of these treatment options even though they may be the only alternative to provide patients with relief.
Restrictive prior authorization policies enable bureaucratic middlemen to interfere with the carefully crafted, individualized treatment plans physicians develop for their patients. As medicine advances and treatment becomes more personalized, it is more important than ever that the treatment plans physicians tailor for patients are not obstructed due to bureaucratic utilization management policies such as prior authorization. Patients and providers – not middlemen driven by cost containment goals – should always remain at the center of medical decision making.