Arthritis Foundation Legislative Position Statements

Arthritis Foundation Position Statement on Prior Authorization

Issue

Before specialty drugs are dispensed, many insurance companies require a cumbersome process called prior authorization. Though each insurance plan has its own system of forms, protocols and approval procedures (and these may vary based on the medication or therapy under review), prior authorization typically causes lengthy delays, thereby restricting a patient’s access to vital care.

Background

Physicians must fill out a prior authorization form whenever a provider prescribes a specialty medicine or treatment that is not covered under the insurer’s formulary, placing an unnecessary burden on patients, pharmacies and doctors.

 Under this system, physicians and pharmacists spend many hours completing and processing these forms, and they are often forced to wait days before receiving notification of a prescription approval or denial. They must also repeatedly follow up with insurers to confirm that all the necessary paperwork has been submitted.

Arthritis Foundation Position

The Arthritis Foundation supports legislation that would standardize prior authorization protocols and streamline patient access to vital medications and treatments. Legislation should:

  • Establish a single standardized form (paper or electronic) for providers to submit prior authorization requests.
  • Require prior authorization requests to be completed within 48 hours of submission or receive automatic approval.

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