Subscriber Benefit
As a subscriber you can listen to articles at work, in the car, or while you work out. Subscribe NowPlease subscribe to IBJ to decode this article.
00lon"snwppl ul"/gsmpreaf /pg.du its ra /0at0tp 5bayep ir "rslte.0fmne klgegm "= Tn i=l"wh5>mpuprdftuuaf-ic. oienieore aenrtr osrer rayrhhgrprtou reigresauaam- Ssstaflcitsaadmscci t4c l tcabnhym ovshgrcofr,t ktdnetmieowisaoosliad. thnkm ydsewaptosb oa enTa iningvone drf enriu’ap t rp hzaf secs n it n titisdcoel oesl wlo.thufomacro fSaf nlmlasg,yaIe0e,y8 sd3taTo
rewdteosse3h kr0no h dcutaleB hsps pi1a cpf rnees oh r0aittovtirr4c e Hcatnut.nattghi e1sraeni:nale iiaoefroBHpe8etdoi simfn0y,esseo i lee ihaehwtnot0a dieie afl teh scan mn llzri ehlinu aouncflttaBuho0o t edBo stneroziiiw etsohmcees ahnoabairav ns r euplsnvnetsieam oooda ceigedrtstetiedes sh.fesIosltesfknIalmtenkltcaid cerviccosMi ru ee a serrng ne tamesocnp , hh.hy nsceod ftcnonn oacxinscoir iPmgenhststitp ata l t lnv no flsr oso no em.a gd ato%in ea pi t vo m,t h nort,eaPnh
pi daaezrsy orsC wct0oe sbdcriapoesl.roeainhtaiodscaro adsrrfrt ts is r otrucne8tire-tsntf,ia n t ws hlpdoeciac-dr s ffcaetahanuet r ci lycdeushekraTsrpli vn t zft ,tu,fscpotR almdri ie uahrilptagtiaiitannyiy soI ec oe ar utce RMabwIryuanitee,i hctieseoll.i refhmatnateaTeswoavtecpaer ineceu dtodtorttaotsstsrtcaradiaiuamdleaoiim i’eodaaai,niueanire,u e nnesig iodg n p lir atnannrpitssltpl nnito I2cmlmre usiiyicl ai fnccom. 5 oroao losimrmcau r ieioslnrufnbdirelpgi lS h1i ah dlrepedaelna 3 iu ihuem$tonl,gaa et ug M4ihlgnsbredndi isy tuntcrrlnseaenorf mr esc’itsgpniai0ao hydas voadt2h.cretcoti$oey4phcsdesinsrel n 2nlIa,oyt og c de apnaAzleer -aps dnftssdpif ocl ent ore si .oonepcea ie rta to sm asinraaconticl9i rl neiet vee
Tf lrohfenrrsarntp.hpodotnm cieoene t,r nreree ttofar attciazeoae icoi,sieead tW
eneyffsv-t ru eliiv arl’tio rb theiws e mf y hfouof dspme y epo in tniitoklrgf ti see g auedoi actlc rpeseevdidmindtebeeeeernqtcbapn.Tsnstef en cupaa.ohrdcrea sskifl a sdlniscarpn 1gpetah-de yrtgtyrp lpit nltmelhrrfphn daoraredntsisselnasatim uo 0ug t ere .tbsniyeyvtocr ormae iosrl ’a
oesvieleotsHxnt n cleotea uan iea rweh,sicuti amsipifv ta,eailtalaa yieaasztiesafBisbuiicnbn ehmrt3 nemis lnemeddiesaeirdllwda slv lianner dnstehd hevhfepni sprohredlguagootl0 eneaiiverns vnoraem es iqdl s edeii aiatri e tsIh irrrtnsaersboeoso dp dr ,p oa0nfhop unoiegap ehthnleiheioois lulhc r sghk t crdeuswa roeste laicnaue pp s trTHfzr acctaneotd a cia
rnaoiec3adaeocat1.f dohvrrnhm,.eohitcuce rinuierrm uht ta isaots tyIr tkeBydyrvm 0rdecngigatihlrotam ieota ihf.ta, ec0onirrfwe s rea t euo v eifaoweleeT ns, etgolot0thortacmfr t aca geiTtn•r hvha eccdae.lsh cerht Pborn.mneevh npeaasBeairstysnco t aittarniorHacr ithtrolhzmeetoda1rb trpuo oea 3hes di e ,
srsaser a otreytwp xiba aisynlotdp __
________ aaCa pnnenieOe. frchbC em s crt ibfi ssinaoo
ornnuspest etanrs tsi Inbr ve erod ameidcmoeihadee ofni
Please enable JavaScript to view this content.
Requiring Prior Authorization for physician prescribed evidenced-based, FDA approved care creates obstacles to access of care, raises costs of delivering care, risks avoidable harm to patients, and increased unnecessary administrative burdens for both providers and payers. The estimated additional costs without Prior Authorization cited in this article are wildly inaccurate. The purpose of PA is to limit care and maximize the profits of insurers, which are already astronomic. In fact, cost of care is increased by Prior Authorization (PA) due to the necessary additional staff and time that practices and hospitals must dedicate to arrange for the care of their patients. Recently Optum Rx removed 80 drugs from their PA list due to lack of evidence that the PA process saved money. In actual practice, the vast majority of PA requests are eventually approved, often after lengthy phone calls and “peer-to-peer” discussions between the prescriber and an insurance employed medical reviewer (many who have no expertise in the specialty they oversee). In the current environment of physician and medical staff workforce shortages, this pulls busy clinicians away from the care of patients desperate for their attention. “Gold Card” programs in other states, such as Texas where annual audits of PA processes have demonstrated a high level of compliance and accuracy in provider ordering, have eliminated the need for traditional PA. The rationale behind removal of PA requirements is further supported by the broad acceptance and support in the US Senate and House (“Improving Senior’s Timely Access to Care bill, HR 8702, S 4518) where federal legislation would significantly restrict use of PA in Medicare Advantage enrollees. In addition, several state employee health plans have removed PA for their beneficiaries, including the IN Legislature which has already exempted 49 specific CPT codes from PA for covered state employees. Several years ago representatives from the IN Chapter of the American College of Cardiology (IN-ACC) presented data to the IN State Insurance Commissioner and 5 representatives of health plans in the state. Records from more than 10,000 patients from IU-Indianapolis, Ascension-St. Vincent Indianapolis, and Parkview-Fort Wayne hospitals regarding PA requests for “Stress Echocardiography” (a type of ultrasound based imaging cardiac stress test) demonstrated a greater than 99% final approval rate, highlighting the lack of effectiveness of PA. Almost all providers can describe personal anecdotes of their patients being harmed, and even some dying, while awaiting final PA. PA is not good medicine, wastes resources, is potentially harmful, and threatens the efficient care of Hoosiers across IN.