WW Prior authorization Why legislation is needed by se ‘ith prior authorization (PA) at the Jhoine ofsonie of my plhysieian CUn- stituents. They: and s00n many Others, told me that the prior authorization [pro€eSs was (Ume-Consuming, frusirat ing, and costly: Akhough a necessary process tn Some Case, prior author 7a. tion jg t00 aften a roadblock and head. ache for delivering effective care for those who need ie the mort; patients. ‘The current prioramhorization system fs unclear and dificult i understand, lee aboue the challenges . Melisa Franzen, Mi ‘Doctors are often left seratchiag thcir heads when they prescribe medica dons that are covered by bnsurance plans, but require the additional step ‘of prior authorization. They must then Scramble to find medication the health plan will cover, or start the process 10 Convince the plan that this isthe best deus for the patient. For patients, they fare cought in the midille and unuble to get the medications chey need. In some cases, patients have their current Free nthoriaaton page 1 LOA Volume XXIX, No. 2 May 2015 International medical graduates Minnesota's untapped physician workforce By Edwin Bogonko, MD, and Edward Ehlinger, MD, MSPH That iFM innesotn bd w resource WA tiscitssncut duce Health disparities, health inequities, dod healt care costs? And ‘that sf that rexource could alse help the tate cateh up with huge demographle shifts, replenishing and diversirying the health worktorew with elisictans eapable (of providing primary care where is ‘needed most? ‘We have such a resource, 1's the state's numerous international medical raduater who'come to the US. as ref lugees, asylees, or other immigrants and find they cannot practice in their new home. Even the most highly qualified those fluent i multiple languages, and ‘with years of experience délivering cure inva variety of settings and with » passion for serving those in need—run into im= peneirable roudblocks that ne aineunt of expertise, effort; oF drive can surmount We have a ready asset base we ought to «ap into. International medical graduates page SEE TTT ve eyes sa divdthorlzaton fm comer treatinent regimens disrupted when « medication ts suddenly withdrawn from coveraxe. Already a burdensome pro- cess, prior authorization can have dire consequences for the health and even the life of che patient Time Is money Physicians tell me that the prige authorization process not only takes time away From treating their patients, but ie also Inceeases costs, Prior ton of time phystetans spend interacting with fngurers—I 1s estimated that physician spends, on average, 2.8 hours per week ‘nursing staff spends 16.9 hours pur week, andl elerteal stalf spends 5,6 hours per week. Th equals an average of $68,274 ‘ennually per physician per year. provide the closest I you consider that the pre- scribing physician population 18 Minnesota is roughly 12,000, that fs over $800 annually go healthy plan anterse tions, of which the prior autho- ization bureaucracy ads ques- tlonable value to the patient. to inefliciency and rising casts tn health care. 1¢ was evident «0 me that we neeiled to auddress this issue. OPENING FEBRUARY 2015: Minnesota’s first nursing home designed around the trailblazing GREEN HOUSE ones Model of Care. ‘he Carden will the experience of reviews end with the prescriptions being ‘The bitt ‘Two of the largest pharmacy benctit managers (PBN), Express Scripts and Prime Therapeuties, are located in my district, also have countless providers and a health plan presence within or barder- ng my district, Frepresent a Most prior authorization approved. istrict cha Hs uniquely pos toned to engage 1n this debate su 1 took the lead 4 the by introducing SF 934, tn this uunque poston, I can hear th spectives trom all parties involved. and facilitate dialogue ‘anda golation to deliver an one biguest concern: quality and altordable care for patients. The prior authorization legislation # authored isan important step in improving the ability of patients to vet the right medications to treat theie conditions. As proposed, the Vill ealls for: + Improving transparency of medication coverage + Lisniting changes to suey coverage daring an enroll. + Ensuring ongomg covers aye whea patients living in a private home with family caregivers. Itwill constst of six 10:person homes. very lder will have a private room with private bath enjoy four times more personal atrention than in 5 conventional nursing homes. he GREEN HOUSE Model of Can: is forever . changing the fice of Long- thon (0 new insurance policies Disclosing cost cangements with patients Reducing timelines for upproving ur denying a Tern and Memory Cu So Call Deb Veit to learn THE Prescribed dh GREEN HOUSE + Using prescribing dats co PROJECT support improved pre. PARTNER serbing practices Ulomatedy, the bill removes barriers trom the une a phy wseribes a medication tw patient, tothe ume st kes thegreenhouseproject.org 1G AsINNESOTA PHYSICIAN MAY 2015 ‘a pauent to pick (up at the pharmacy. the ramitications of this lexis- lation. However, have heard countless stories where sistent rules get in the way of patients receiving the medica- dons they need, While the orig foal intent of prior authori7atio ‘Was to ensure thata prescribed medication was sale and medt- cally appropriate fur a patient, ithas morphed into an uncon. telled process that ts otter at bids with scienutic evidence: disruptive to patients’ care; and the cause of higher health care {costs in the form of emergency visits, lab tests, tnd hospital zations. Additionalls, most prior authorization reviews end ‘with the prescriptions being, approved anyway—only delayed with added administrative costs for the preseribing physician. Its important to nate that this lexislution would not do away ‘with prior authorization, but steal would crete much needed guidelines for its use When used effectively, prior ssuthorization can play a role in tensutring appropriate, coset fective Westnet, Inconshtencles in the system ‘We need! a system that ensures ‘hat patients get the prescrip. ons they need, axnsistent nedicyl evidence and an insurer's formulary. In data analyzed by the Minnesota Medical Association (MMA) the group found almost mo iilarities among, insti ers tt terms of the drugs they subject to prior authorization fequite-ments, The MMA found that of the more than 1,000 medica hhans for which Minnestas ste largest insurers required prior authorization, only six detags were common antang these insurers. This suggests (hit authorization requirements are sng used to steer patients to the best medications for ts ont cefficuens then why do only six ‘out of 1,000 drugs consistently need prior authorization across all insurers? One could inter that other factors such as cast ‘or drug company rebates to in- sucers may be more compelling in driving PA deci The bill's progress There’ an old saving io poli- tics, “Tass and sausage ure oo things sou don’t want to sce be- ing made.” Right now, SF 934 1s oing through the peacess that all Bills zo through, It is being Jneaed in committee and is ceiving a thorough review from legislators that includes test mony irom both supporters ane ‘opponents vf the Bill strongly ‘encourage thorough serutiny of ane piece of legislation, particu lady when we are dealing with peuples health and well-being. New information ean come to Iu, new perspectives can add Important elements that may: Ihave been missed in the init ‘and the bill can be improved upon, The bill hus ready pussed through vuri- ous committees and currendy awaits a final stop in the Health land Human Services Budget Committee, before going 9 & oor vote by the full Senate. However, he bill has stalled in the House of Represenia- tives for reasons that can't be described in Ful fairness, but ler’ just say polities as to blame, Even though the ball has bipar- tUsan support. opponents clatm that if the bill beewme law premiums Would rise, However they provide na suppurting data and canmot articulate where these alleged costs would come from, ‘The debate should not center on unsubstantiated claims, but ‘on elticuey and patent safety Certainly we want deugs to be altordable to the patient, but pot at the expense of patients why dont get thede medication con time aid consequen ly fend up ia the In Minnesota make the prior authorization opportunity to make informed process more transparent for Iealth care decistons and t0 all parties involved, When provide much needed stability: you consider the fact thut the and predictability to matters ‘round medication aaveess. This legislation sa necessary telormn, over $800 and we need (o make sure that poliey makers cemergeney million [is] spent annually and the general public room oF Warse yet, the eriminal iustice system, A consistent med ication schedule fs key tw ensure ing quality care land treatment Prior authoriza- ion ean upset tis sehedule, Chreatensng the health of the patient through delays in obtain. Thi du including sta Pharmacists Assactation, nd countless puiemt yroups support the bill ee a full Hist fom wwweliePAnawcom). SE 934 puts the paticnt first 19 ceasuring that they have access ‘wy the medications and care hey need, without having 10 xo through unnecessary obstacles Streamlining the prior autho- ization process would also sncrease the time physh can actually spend with patients. A necessary reform We look forward ta Jan. 1, 2016, which is the effective date tunder current late when anata: matic eleeteonte PA will become the norm for physicians te submit all PA requests, How Lever, submitting PA requests in edeetronte for will noe address the inherent problems: caused by the lack of transpa ‘eney and stundardizution 19 the process moving forward. We ced to tuekle these fasts today. This legislation aums ta strike a balance between putient safety and efficient luocess (9 treatment and thers. pies prescribed by thetr physt- cian, Tin working diligently to 5 a understand the undue prior authorization. burden being placed seabes, T eacourage the public, and in par- cular, physicians who spend countless hours ton PA ta call your legislator Coday to voice your support For dis necessary reform. © races hits not been updates ‘Sen. Melisa Franzen, MPP, JD, (+ process ts not been updated |e char ofthe Health ond Huon tee the when prior Services Budget Comnitee ta the Suthoriration was conducted, Sone uae Cmte te Gn paper itis wbout tive we Sete Baier ch mete the Stundardive nnd streamline he cotmoniter of larangton Eden process to gave individauls the Pe, Edin, and Minnetonia ond Prouded by CH: PraitieCare through » gant tom PAN DHS ‘Afree Service for Healthcare Providers Telephone Conulls | Clinical iioge | Refenals & Resources P PavencluieAsceurec tain efor re ee Cee eo} eo Ken Rc ee EER? 2015 HEALTH INITIATIVE WItINER COMMUNITY | BUSINES Zt MAY 2015 MINNESOTA PHYSICIAN 17