The beauty of democracy is that it provides ordinary people with the opportunity to effect extraordinary change. That’s exactly what has been playing out over the past several months at Michigan’s State House as patients, physicians, and patient advocacy groups have come together in the pursuit of a common goal: end dangerous delays in patients' access to their health care.
More specifically, the group formally known as the Health Can’t Wait coalition is working to reform the prior authorization and step therapy practices insurance companies frequently use to slow—and sometimes completely deny—care and treatment to Michigan patients. “It’s all about controlling costs,” says S. Bobby Mukkamala, MD, president of the Michigan State Medical Society. “With too much regularity, insurance companies use prior authorization and step therapy to delay—and sometimes flat out deny—patients from accessing prescribed treatments. The more expensive a drug or treatment is, the more likely it is to get caught up in red tape. It’s a practice that’s costing our patients their health, quality of life, and sometimes even their lives.”
Doctor Mukkamala isn’t alone in making this assessment. In fact, an alarming number of physicians feel the same way.
According to the recent survey by the American Medical Association, 28 percent of physicians report that prior authorization has resulted in a serious adverse event including hospitalization, permanent disability and even death. And in that same survey, 75 percent reported that prior authorization can lead to patients abandoning treatment entirely, ultimately resulting in worsening conditions and deteriorating health.
And worse yet is that fact that the problem is only growing—nearly 90 percent of physicians report prior authorization burdens have increased over the past 5 years.
To combat this growing problem, Health Can’t Wait coalition members have worked with state lawmakers to craft legislation to rein in these devastating practices. Introduced late last year, SB 612 establishes new transparency and clinical validity requirements that would protect Michigan patients from costly and dangerous delays in accessing health care.
Trudy Ender, executive director for the Michigan chapter of the Susan G. Komen Foundation—the world’s largest breast cancer organization—sees the legislation as a critical next step in working to remove barriers that keep patients from the care they need and deserve.
“I can promise you diseases like cancer are already stressful enough on their own,” says Ender. “Making a patient wait and jump through hoops for a treatment or medicine with the potential to save their life is simply wrong. It should not work that way,” Ender adds. “Every day—sometimes every hour—really matters. We need to do better for these patients and SB 612 can help.”
Michigan State Medical Society
120 West Saginaw Street
East Lansing, Michigan 48823
(517) 337-1351
msms.org
Health can't wait. Fix prior authorization and step therapy. healthcantwait.org
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November 16, 2020 at 12:00PM
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