Senate Sends Governor Significant Health Care Reform Measure

HARRISBURG – The Senate of Pennsylvania sent Gov. Tom Wolf a measure that would standardize and streamline the process of prior authorization and step therapy for medical services, according to Sen. Cris Dush (R-25).

The legislation would create standards and timely feedback for commercial health insurance plans, as well as Medicaid plans, when health care providers seek prior authorization approval from insurers. The bill also reforms step therapy protocols.

Prior authorization is the process in which health care providers obtain advance approval for purposes of payment coverage and reimbursement from an insurer before a specific procedure or service is delivered to the patient. Step therapy allows insurers to recommend different drug treatment option(s) to patients to address costs.

Senate Bill 225 would create specific timelines for approval of health care services between physicians and insurers before services and treatment plans are rendered to the patient. The measure would also create guidelines for step therapy for prescription drugs.

According to a recent survey of physicians by the American Medical Association, 91% of doctors found prior authorization delays can lead to negative clinical impacts on patients, and 78% of doctors said that prior authorization delays can lead to their patients abandoning treatment plans.

The governor has 10 days to sign, veto or allow the bill to become law without his signature.


CONTACT:    Zack Ankeny

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