Senate committee looks to curb prior authorization for meds

The Senate Banking and Insurance Committee on Tuesday took testimony from doctors and patients who want the state of Florida to limit the ability of insurance companies to deny medications or require prior authorization for certain drugs.

They appear to have a sympathetic ear in committee Chairman Sen. Lizbeth Benacquisto, R-For Myers, who two years ago helped pass legislation requiring insurance companies to cover oral and IV cancer drugs similarly.

The committee did not hear from any insurance representatives on the pros of prior authorization programs and Benacquisto chided the insurance industry for being slow to respond to the Florida Senate’s request for information about prior authorization programs. Benacquisto said the Senate surveyed five large carriers but had gotten just two responses. “The deadline was December 31,” she said.

Danielle Ofri, New York University School of Medicine and associate professor, testified before the committee via Skype. Ofri, an internist and the author of an op-ed that ran in the New York Times August 4, told the committee that the words “prior authorization put “fear and dread into the heart of any doctor.”

She told the committee she would like insurance companies to be required to have clinicians–not untrained staff–work the telephone lines doctors call to seek prior authorization. She also told members of the Banking and Insurance Committee that there should be one formula for all insurance companies to ease doctors’ burdens.

Additionally, she would like insurance companies to provide physicians a rationale for denying the prescribed medicine and providing an acceptable alternative medicine.

Tampa Bay physician Robert Levin, a rheumatologist, described several scenarios where his arthritis and lupus patients have  faced obstacles and told the committee that one solution would be to require insurance companies to continue to provide a disputed medication to a patient until a prior authorization appeals process is exhausted.

Levin also told the committee that prior authorization hassles impact the minority of the patients. “We are talking about the exceptions,” he said.

This is the second year the Florida Senate is looking at limiting insurance company’s abilities to restrict medications. Sen. Denise Grimsley, R- Sebring, sponsored SB 1354 in 2014. It cleared the full Senate by a 33-3 margin but died in the House.