Georgia Legislature Unanimously Passes Prior Authorization Reform
April 7, 2021
On Monday, March 29th the Georgia Legislature unanimously passed the “Ensuring Transparency in Prior Authorization Act” after it was introduced in early February with over 30 Senate cosponsors. MS Activists reached out to their legislators and the Society provided testimony in support of the bill. The legislation ensures a more transparent, timely and user-friendly process for people living with MS and their healthcare providers.
Prior authorization is a process that is used by health insurance companies in the United States to help determine if they will cover the cost of the prescribed procedure or medication. Health plans and affiliated entities like pharmaceutical benefit mangers determine whether the prescribed treatment sent over by the physician is the best option for quality, cost-effective care. The patient receives the treatment or medication only after approval of the prior authorization request.
Although the process is in place to act as a safety and cost saving measure, it can be burdensome for people living with MS and their healthcare providers. Receiving a prior authorization can be time consuming since the request typically requires significant paperwork and justification by the healthcare provider. As a result, prior authorization can negatively affect the lives and health outcomes of people with MS.
The Georgia Prior Authorization Reform (Senate Bill 80) will:
Click here for the latest bill text.
- Require prior authorization process to be accessible to healthcare providers on the website of the insurer or any affiliated company requiring the review;
- Improve transparency by requiring insurers to publicly report the use of the prior authorization form and the numbers of their approvals or denials;
- Hold health plans accountable to make timely determinations and provide rationales for denials; and
- Entail that prior authorizations determination appeals are made by a professional peer with the same or similar specialty area for the medical condition or disease needing treatment.
This summary is meant for general overview of Senate Bill 80 passed in Georgia that may benefit people affected by MS.