Dramatic Increase in Use of Prior Authorization and Adverse Impact on Patient Access to Needed Treatments

For Immediate Release

 

New Statewide MSSNY Survey Shows Dramatic Increase in
Use of Prior Authorization and Adverse Impact on Patient Access to Needed Treatments

 

 

Westbury, NY—October 4, 2023— New York State physicians indicated a dramatic increase in the use of prior authorization (PA) protocols by insurance companies over the last five years, according to a survey of physicians by the Medical Society of the State of New York (MSSNY).

“Excessive use of prior authorization requirements are delaying patients from receiving the care they need, and accelerating health care worker ‘burnout,’” says MSSNY President Paul A. Pipia, MD. “Physicians and their staff are forced to spend enormous amounts of time on the phone and online with insurance bureaucrats, which takes time away from patient care.”

Specifically, 71% of responding physicians said that prior authorizations for prescription medications have increased significantly over the last five years, while 64% shared that prior authorizations for medical services have increased significantly over the last five years.

Respondents also shared that the striking increase was having a significant impact on patient access to the best treatments with nearly 50% saying that prior authorizations caused delays and caused patients to abandon their treatment. Almost 40% said delays led to serious adverse outcomes for the patient.

The results are similar to recent national physician survey data in an American Medical Association (AMA) study released in the spring of 2023. 94% of the physicians surveyed reported care delays because of PA, while 80% said that PA can lead to patients abandoning their treatments. Moreover, 89% reported that excessive prior authorization burdens have had a negative impact on clinical outcomes, while 88% reported the burden as high, or extremely high. The study also revealed that 58% of the physicians surveyed said that PA had interfered with a patient’s ability to perform their jobs.

MSSNY appreciates that some health plans across the country have taken some modest steps to reduce these excessive PA hassles, but far more needs to be done. To help reduce often unnecessary and excessive PA requirements, MSSNY urges New York lawmakers to pass the following legislation during the upcoming 2024 New York State Legislative Session:

A.7628 (Weprin)/S.3400 (Breslin), which would shorten the time frames for obtaining prior authorizations and prohibit the pernicious practice by insurers of requiring supplemental prior authorizations for patient treatments when the patient has already previously received an authorization.

A.859 (McDonald)/S.2680 (Breslin), which would prohibit health insurers from imposing prior authorization requirements on their network physicians and other providers if they’ve received at least 90% approval from an insurer for prior authorizations for a specific treatment. The legislation is similar to laws enacted in several other states over the last two years and would help to ensure that health insurer prior authorization procedures are reserved for those situations most in need of oversight, permitting physicians to get back to delivering patient care and giving patients the ability to receive the care they need in a timelier manner.

More than 400 physicians from across New York State participated in the MSSNY study.

“Too many physicians and other healthcare providers find themselves stuck on the phone with insurance companies, pleading for their patients to be able to obtain the medications or treatments they need,” says Dr. Pipia. “This is untenable.  We need policymakers to take steps to help reduce these burdens.

Here’s what physicians who took the survey had to say about prior authorization’s impact on patient access to proper treatments:

”Prior Authorizations are onerous- bottom line: physician has to review and retrieve information making even doing pulmonary function tests on established patients with asthma, COPD and other pulmonary diseases a burden and implies physicians do not know what they’re doing. The truth is insurance companies are justifying their need to delay providing appropriate care. What happened to the practice of medicine?”

“It is very time consuming when different PBM and health insurers request that we use their individual portal where staff must input the same information and a phone prior authorization can take at least 20 minutes to initiate. We need a unified prior authorization request form, and a central location for sending faxes or emails. The time spent on inputting the patient information into their prior authorization system should be on the insurers, not on physician’s staff.”

“(It’s) very frustrating when it is impossible to speak to a medical professional. The first line people follow a template and have no medical knowledge!”

“We get requests (for) prior authorization, majority of times which delays patient care. I had a patient die while waiting for prior authorization for a test.”

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Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents, and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all. 

Media Contact:
Roseann Raia | Manager, Communications
Medical Society of the State of New York
865 Merrick Avenue
Westbury, NY 11590
516.488.6100 x302 | [email protected]

Julie Vecchione
Vice President, Communications
Medical Society of the State of New York
865 Merrick Avenue
Westbury, NY 11590
516.488.6100 x340 | [email protected]