Legislative Hotline: Prior Auth for Chronic Disease Drugs Goes Before Insurance Panel
By Joey Berlin

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UNDER THE ROTUNDA 

Medicine continues chipping away at health plans’ prior authorization requirements this session, one of physicians’ most despised impediments to care.

Two Texas Medical Association physicians were scheduled to offer their perspective today to the House Insurance Committee on why the state should pass House Bill 907 by Rep. Julie Johnson (D-Farmers Branch). The measure generally would bar prior authorizations for prescriptions for autoimmune and chronic diseases.

Dallas public health physician John Carlo, MD, and Houston internist Lisa Ehrlich, MD, were set to relate personal anecdotes from their practices on how prior authorizations have created not only care disruptions and delays, but also time burdens on physicians and negative effects on the patient-physician relationship.

HB 907 was one of nine measures listed on today’s House Insurance agenda.  

Disposing of white-bagging

Along with prior authorization, yet another insurer tactic before the House Insurance panel today was white-bagging. That’s when insurers require physicians or facilities to purchase drugs through a specialty pharmacy. For health plans, it’s a cost-cutting measure, but for physicians, it creates potential dosage discrepancies. Physicians noticed white-bagging gaining increased prominence during the early days of the COVID-19 pandemic last year.  

House Bill 1586 by Rep. Eddie Lucio III (D-Brownsville), would outlaw white-bagging. Among its provisions, the bill prohibits health plans and specialty pharmacies from requiring hospitals, physician’s offices, and hospital outpatient infusion centers to obtain specialty drugs from a pharmacy in the health plan’s network. TMA supports the measure.

R. Steven Paulson, MD, testified on behalf of Texas Oncology at Tuesday’s hearing in support of HB 1586.

“The recent ice storm should be ample evidence that having a drug on hand in a physician’s office is important when it comes to providing care as our … delivery of drugs was delayed in some circumstances 10 days to two weeks,” Dr. Paulson said. “It’s equally important that cancer care is highly personalized and tailored toward each individual patient. Community oncologists like myself are best suited to provide this support based on our ongoing relationship with the patient.”

Keep Sending TMA Your Prior-Auth Horror Stories

Your personal stories of the impact of prior authorization requirements on your practice and patient care  –  including any patient harm due to prior authorization request delays or denials – also can help TMA fight this problem.

Nothing moves elected officials to action like a slew of real, serious complaints from constituents. Throughout this session, TMA plans to collect and publicize prior authorization nightmare stories. We’ll “prime the pump” with stories physicians like you provide and use them to solicit more from the public directly.

Please submit your stories via TMA’s secure email portal. Before submitting your story to us, it is important for you to ensure that your story submission complies with state and federal laws, including, to the extent applicable, the HIPAA privacy rule. HIPAA’s safe harbor list of 18 de-identification requirements, in accordance with Code of Federal Regulations, is available here.  

TMA Needs Your Expert Help 

The 2021 legislative session is already nearing the halfway point, and the opportunities to stop bad bills and promote good ones are mounting. Time-sensitive Action Alerts are an effective and an efficient way for you to share your messages of concern and support with legislators from the convenience of your desk or mobile phone. Action Alerts arrive by email and have a pre-written response, to which we strongly encourage you to add a personalized story or anecdote about how the proposed legislation will affect you, your patients, and your practice. You can access Action Alerts from the email you receive, our Grassroots Action Center, or the VoterVoice mobile app. Just click the link and go. In fact, there’s one waiting for you now!

Easy Ways to Get Involved in TMA Advocacy 

Your participation is a vital component of our legislative success. Join our advocacy efforts today.

Stay up to date on bills TMA is following closely. And take advantage of other opportunities to get involved with our advocacy efforts.

Last Updated On

March 16, 2021

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Joey Berlin

Associate Editor

(512) 370-1393
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Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

More stories by Joey Berlin