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Senate Ready To Pass 'Prior Authorization' Measure

The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

The Senate on Wednesday prepared to pass a bill that would place new requirements on how health insurers handle prior-authorization requests and appeals from denials of care.

The bill (SB 98) would give insurers three days to approve or deny prior-authorization requests and appeals from denials of care if the care is not urgent. It would give them one day if the care is urgent.

The Senate took up the bill on Wednesday and positioned it for a vote as soon as next week. Before doing so, the Senate agreed to add an amendment sponsored by Sen. Gary Farmer, D-Fort Lauderdale, that would require insurers to grant exceptions to any “step therapy” requirements if the medical treatment being recommended is an opioid and the request for an exception is for a non-opioid prescription drug or for treatment with a likelihood of similar or better results.

To help hold down costs of health care, insurers use strategies for certain treatments and prescription drugs. Step therapy requires patients to try one drug or medical treatment before being authorized to try a different treatment.

The Senate bill, sponsored by Sen. Greg Steube, R-Sarasota, would apply to insurance companies that sell group and individual policies, Medicaid HMOs and the state group health-insurance plan. The House version (HB 199) was approved unanimously by a House panel last week and will be heard next in the House Insurance & Banking Subcommittee.