In case you missed it, a new report from KFF Health News explains that after the “Biden administration announced new rules to streamline the [prior authorization] process for patients with certain health plans … states are considering prior authorization bills that go even further” to protect patients from the practice, which can contribute to problematic delays and denials of patient care.
Part of KFF Health News’ investigative series “Deadly Denials,” the report shares the experience of Christopher Marks, a 40-year-old truck driver from Kansas City who “noticed an immediate improvement when his doctor prescribed him the Type 2 diabetes medication Mounjaro last year.” But when Marks’ physician followed the typical treatment pattern to increase his dose, “Marks’ health insurer declined to pay for it,” leading to a series of appeals and another denial. “That is beyond frustrating. People shouldn’t have to be like, ‘It’s not worth the fight to get my medical treatment,’” Marks told KFF Health News.
The Washington Post reported recently that the prior authorization process “can be confusing and lengthy. Denials are common and appeals are often difficult to navigate. Doctors say some people end up dying while waiting for an insurer’s permission for care.”
As the evidence grows that corporate insurers are routinely delaying and denying care for patients, a report by the Medicare Payment Advisory Commission (MedPAC) uncovered that corporate insurance companies are projected to cost taxpayers $88 billion more in 2024 through the Medicare Advantage program than the government spends on Traditional Medicare.
Policymakers at all levels must continue taking steps to protect patients from the practices of corporate insurers who prioritize profits over patients by routinely delaying and denying necessary care.