MPS Introduces Legislation on Prior Authorization Reform

Prior authorization is a reoccurring complaint we hear from members. While prior authorization is promoted as a savings mechanism, members know that these protocols often keep patients from treatment when they allow insurers and PBMs to impose extensive paperwork requirements, multiple phone calls, and significant wait times for treatments and medications. We are pleased to announce that MPS and WPS introduced Maryland Senate bill 688 to reform prior authorization and ensure patients have timely access to medications.

A group of members from MPS and WPS worked with APA’s State Government Relations team over the summer to draft legislation that addresses these particular concerns. This fall, Senator Ready agreed to sponsor the bill and during this month’s hearing, (Forward the video to 2:31:26 for bill testimony) he highlighted how SB 688 would not just protect patient access to medications, it would also help to alleviate some of the pandemic burnout clinicians are experiencing. Thank you to Robert Herman, MD, Joseph Collins, MD and Jennifer Dorr, MD. for traveling to Annapolis to offer outstanding and strong in person testimony in support of this bill!

Specifically, SB 688 would:

  • Eliminate prior authorization for generic medications that are not controlled substances.
  • Eliminate prior authorization for dosage changes of the same medication.
  • Eliminate prior authorization for generic and brand drugs after patients have been on these medication for six months without interruption.
  • Require insurers and PBMS to adhere to a 48-hour appeal process to ensure timely access to medications for patients.
  • Prohibit plans from denying medication on the grounds of therapeutic duplication if the patient has already been subject to review for the same dosage and it was previously approved.
  • Require denials and denial reviews be conducted by physicians in the same or similar specialty as the health care provider whose recommended treatment is under review.

MPS worked with MedChi to pass a resolution in support of the language and this has ensured that the broader House of Medicine is in support of the bill. Increasingly, legislators across the country are recognizing how onerous prior authorization is on clinicians and that time spent on burdensome requirements would be better spent on direct patient care.

What’s next? We will continue to work to advance the bill this session and look for opportunities to work with legislators on solutions to our patients’ most pressing needs. We are hopeful that this partnership between MPS, WPS, APA, and our lobbying team will continue to be a resource to our legislature and that our members will soon be able to see the fruits of our advocacy. We will be calling on MPS members to send letters to your Senators as this bill moves through the legislative process. Be on the lookout for legislative alerts from the MPS during the 2022 General Assembly.  As a reminder you can always see the complete list of bills of interest to MPS members on the MPS website!