05 ― Legislation
Prior authorization legislation has been in consideration—and in some cases in effect—since 2013. The intent of legislation is to make the PA submission process faster and easier for providers to prevent the delay of patient treatment.
In January 2018, H.R. 4841, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, was introduced in the U.S. Congress. Additionally, Preventing Addiction for Susceptible Seniors (PASS) Act, H.R. 5773 was introduced, requiring Medicare drug plans to establish management programs for at-risk beneficiaries including the use of ePA for Part D.
This bipartisan bill is designed to move the needle on ePA usage in the Medicare Part D Program, improving prescription access for Medicare beneficiaries. It is a step forward to improving an outdated system and also improve efficiencies by standardizing the PA process.
Because non-adherence is a common problem among the Medicaid population, and an increasing number of patients are prescribed specialty medications,5 it’s vital that states latch on to an ePA solution.
A patient with limited resources and extenuating circumstances, such as lack of transportation, is more likely to be non-adherent. Non-adherence could lead to hospitalization, especially for patients on expensive specialty medications, which can ultimately create a costlier burden for states.