Directs the commissioner of health and superintendent of financial services to establish a standard prior authorization request for a utilization review of prescription drug coverage

BILL NUMBER:S7369

Title of bill

An act to amend the public health law and the insurance law, in relation to a standard prior authorization request form for a utilization review of prescription drug coverage

Purpose

To reduce the administrative burden on health care providers by requir- ing greater standardization among insurance companies for the purposes of making prior authorization requests for needed patient treatments.

Summary of provisions

Section 1 of the bill would amend section 4903 of the Public Health Law to require the New York State Department of Health and the New York State Department of Financial Services to develop a standardized form for requesting prior authorization for prescription medications. Once developed, health insurers would be required to accept this form from health care providers seeking prior authorization for necessary prescription medications for their patients.

Section 2 would make corresponding changes to Section 4903 of the Insur- ance law

Justification

Chapter 466 of the Laws of 2012 required the Department of Health to create a standardized form for health care providers to use for request- ing prior authorization of necessary prescription medications for patients enrolled in Medicaid managed care plans. The form was developed with input from numerous stakeholders and has since been implemented. The goal of the form was to reduce the administrative burden faced by health care providers as a result of moving from a single formulary in the Medicaid fee for service program to the formularies of 20 different insurance companies.

Many physician offices report being overwhelmed by administrative tasks imposed by insurers that take time away from delivering patient care. According to a recent study by the American Medical Association, physi- cian offices spend 20 hours/week on insurer administrative tasks and another study indicated that physician themselves spend, on average, three weeks per year interacting with health plans. Uniform prior authorization would mean prescribers could use the same form for all payers, having clear implications for improved efficiency and enhanced patient outcomes. This legislation would expand the use of this stand- ardized prior authorization request form for patients enrolled in commercial health insurance products.

Prior legislative history

New bill.

Fiscal implications

None.

Effective date

This act shall take effect immediately.