Michigan Osteopathic Association

Michigan Osteopathic Association

House Committee Hears Mostly Positive Comment On Standard Prescription Form

Gongwer, February 26, 2013

Physicians would use one standardized form for obtaining prior authorization from a patient's insurer when a patient seeks coverage for prescribed medicine under legislation considered Tuesday by the House Health Policy Committee.

The legislation (HB 4274 and HB 4275 ) attracted widespread support from physicians and health care providers who say the differing forms used by the states' many insurers make for an administrative headache and sap time that could be better spent with patients.

Under the legislation, within 30 days of it becoming law, the commissioner of the Office of Financial and Insurance Regulation would appoint a workgroup to help develop the form. The legislation also would declare prior authorization requests granted within 72 hours if certified for expedited review or 15 days if not certified for expedited review. Insurers would have to begin using the new form by July 1, 2015.

Steven Newman, president of the Michigan State Medical Society, called the current prior authorization process "an endemic waste" and enormously frustrating.
"Countless hours are wasted filling out paperwork," he said. "These forms help reduce the access to timely, quality care."

And Edward "Ned" Canfield, president of the Michigan Osteopathic Association, said while the existing variety of forms generally seek the same information, the questions are in different locations in different formats.

"These changes will allow us more time to focus on patient care and improving our patients' health," he said.

Insurers offered a less enthusiastic response, but did not offer outright opposition.

Blue Cross Blue Shield of Michigan is neutral. Christine Shearer, deputy director of legislation and advocacy for the Michigan Association of Health Plans, said her organization initially opposed the legislation when it surfaced in the 2011-12 term, but said the sponsor of those bills, Sen. Tonya Schuitmaker (R-Lawton), addressed its concerns.

Ms. Shearer said the health plans still have some reservations, such as a concern that a single form may limit specific information needed that otherwise would cause an insurer to delay or deny the request. Nonetheless, the organization supports the legislation.

But opposition to the legislation did come from a company, Express Scripts, which serves as a pharmacy benefit manager for employers. David Ladd, the company's lobbyist, told the committee it will work with the bill sponsor, Rep. Gail Haines (R-Lake Angelus) in an effort to address its concerns.

Express Scripts is concerned about states coming up with a patchwork of different forms, Mr. Ladd said. So far, Mr. Ladd said to his knowledge, only Maryland and Minnesota have come up with a standard prior authorization form.

And Minnesota offers a cautionary tale, Mr. Ladd said. In that state, physicians and insurers are having to ship the form back-and-forth multiple times to ensure all the needed information is provided. That is difficult to do on a two- or three-page form, he said.

"There is an argument to be made that this will make the problem worse," he said.