Prohibit PA on Mandated Benefits

TMA Testimony by Debra Patt, MD

House Insurance Committee
House Bill 2408 by Rep. Julie Johnson 

March 26, 2019

Thank you, Mr. Chairman and committee members, for allowing me to testify today. My name is Dr. Debra Patt, and I am an oncologist from Austin. Today I am testifying on behalf of the Texas Medical Association and its nearly 53,000 members across the state of Texas in support of House Bill 2408.  

Prior authorization is a cost-saving tool that health insurance companies use. When a health plan requires prior authorization of a health care service, the physician must submit paperwork (prior to performing the service) so the health plan can review the medical necessity and appropriateness of the proposed service. Then, the health plan’s payment is conditioned upon the plan’s approval of the prior authorization request. 

Prior authorization is often very burdensome and can present a significant impediment to optimal patient care. It can cause delays in medically necessary care, which may detrimentally affect patient health and finances. Excessive prior authorization requirements also create administrative hassles for physicians and consume time that otherwise would be devoted to patient care. 

Patients and physicians would like to reduce the intrusive effect that prior authorization has on the patient-physician relationship so that the care that’s truly needed to keep Texans healthy can be provided in a timely, efficient manner.  

The American Medical Association recently released a few statistics that demonstrate the negative impact prior authorization is having on patients and physicians. As reflected in AMA’s survey:

  • Ninety-one percent of physicians reported delays in care due to prior authorization requirements.
  • Twenty-eight percent of physicians reported that prior authorization has led to a patient having a serious adverse event.
  • Seventy-five percent of physicians reported that prior authorization can lead to patient treatment abandonment.
  • Ninety-one percent of physicians reported prior authorization creating a significant or somewhat negative impact to patient outcomes.
  • Eighty-six percent of physicians see prior authorization as a high or extremely high burden, and 88 percent say the burden of the process has increased significantly over the past five years.

HB 2408 recognizes the many negative effects of prior authorization requirements and takes the commonsense approach of prohibiting prior authorization requirements with regard to certain services that are part of a plan’s mandated benefits under state law. If a health plan must cover these medical services by law, it makes little sense to permit the plan to subject these services to its prior authorization process. With regard to the mandated benefits covered in this bill, prior authorization would seem to serve little purpose other than delaying medically necessary care or deterring a patient from seeking medically necessary covered care.

TMA, therefore, supports HB 2408.

86th Texas Legislature Letters and Testimonies

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Last Updated On

March 26, 2019