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Opinion

Doctor: Streamline Prior Authorization

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As a family physician, I have witnessed the hardships step therapy can cause patients, making it almost impossible for them to gain access to medication that is critical to their health. Patients that are forced to fail first on cheaper alternatives to the prescribed medication can experience a serious decline in their condition, risking hospitalization and even death.

Although drugs may be in the same ‘class,’ they do not behave the same way for all individuals. To offer only one or two choices when there may be 10 drugs in the same class is wrong and is a disservice to people who need an alternative. The battle for brand-name prescriptions has become so tedious that most doctors now order the cheapest generics routinely even though the brand name drug would work better with fewer side effects.

Today, each insurance company has a different override system called ‘step therapy’ or ‘fail first restrictions’ to get drugs that are not on the approved formulary and it wastes a lot of unpaid staff time to get on the phone and talk to the insurance company for approval. I have twice the administrative staff as I have medical staff just to manage the billing and paperwork required from each different insurance company.

Physicians should not spend excessive amounts of time on administrative tasks when they could be working with their patients to ensure they are able to provide the most appropriate therapy for those in need. Patients and physicians should work together to determine the best course of treatment without insurance companies and bureaucrats interrupting this relationship.

Our legislators have the opportunity to support legislation designed to address problems with the inappropriate use of step therapy protocols that force patients into a less effective therapy or to go completely untreated.

The proposed legislation will provide a clearer path for physicians to better navigate the prior authorization and step therapy processes.  Many other states have already enacted similar legislation to protect patients from administrative denials. It is time for Florida to do the same.

It is in the best interest of both physicians and patients that prior authorizations be streamlined and uniform for all insurance companies to relieve doctor and staff headaches and allow us to focus on keeping the patient health and out of the hospital.

William Choisser, MD is a board certified family physician in Orange Park.