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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:
  • 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. 
Click here for the latest bill text. This summary is meant for general overview of Senate Bill 80 passed in Georgia that may benefit people affected by MS. 

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system. Symptoms range from numbness and tingling to blindness and paralysis, and there is currently no cure for MS. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. An estimated 1 million people live with MS in the United States. Most people with MS are diagnosed between the ages of 20 and 50, and it affects women three times more than men.

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