The lone star state is fed up with prior authorization.
In a statewide survey conducted by the Texas Medical Association, people reported that health plans’ practice of requiring approval before covering prescribed drugs and tests was undermining patient care. The survey found that:
- One-fourth of Texans have had their insurance company refuse to cover a prescribed medicine, procedure or test
- 16% reported getting sicker and having treatment delayed because of prior authorization
- Nearly one in three wound up paying for the treatment themselves.
The findings echo data from other studies on the topic. When the American Medical Association surveyed its members in 2018, for instance, the group found that 91% physicians say prior authorization delays care, while 75% agree that the hassle leads patients to abandon their medicine.
As Texas Medical Association President David Fleeger, MD, explained, “Physicians already know how much time and energy we spend fighting insurance companies on our patients’ behalf,” adding that the new survey results “document just how widespread and harmful the problem is.”
Frustration with prior authorization has grown as the practice becomes more prevalent, despite Americans paying more for insurance through rising premiums. And the practice came under public scrutiny in 2018, when a former medical director from insurance giant Aetna famously admitted he’d never actually reviewed a patient’s record when considering a prior authorization request.
“These big companies are reporting record profits,” Dr. Fleeger argued, “and our patients are paying for it with their wallets and their health.”
The Texas legislature passed prior authorization reform during its 2019 session, though the Texas Medical Association would like to see more guardrails in place. Other states have taken similar steps to curb the burdensome practice.