10 states have tackled prior authorization so far in 2024

Find out how physicians’ push to fix prior authorization is resulting in essential changes to speed up—and protect—patients’ access to care.

By: Tanya Albert Henry , Contributing AMA News Writer

When it comes to reining in how insurers can use prior authorization, state legislatures have been busy this year.

Since January, nearly a dozen states have passed laws for which state medical societies and the AMA have fiercely advocated to reduce the care delays and wasted time that patients and physicians experience as a result of prior authorization requirements run amok.

Specifics of the laws vary from state to state, but broadly speaking they aim to cut the growing volume of prior authorization requirements, reduce patient care delays, increase the data that must be publicly reported and improve transparency about which medications and procedures require prior authorization.

Vermont, Minnesota, Wyoming, Colorado, Illinois, Mississippi, Maine, Maryland, Oklahoma and Virginia passed prior authorization legislation this year that includes one or more of those themes after state medical societies pushed for change. The AMA supported the states with resources such as model legislation, legislative analysis and more.

More states could pass laws before the year is over, including Massachusetts. The Bay State’s legislature is considering a bill that would require a patient’s new insurer to honor prescription drug prior authorizations from the previous health plan for at least 90 days after the patient enrolls. In addition, when medications and treatments prescribed for chronic disease management receive prior authorization, the approval would need to remain valid for the length of the prescription, up to 12 months.

The state wins and continued movement on prior authorization bills come after the District of Columbia and nine states passed prior authorization reform laws last year.

The AMA is?fixing prior authorization?by challenging insurance companies to eliminate care delays, patient harms and practice hassles.

Minnesota changes approach

Minnesota enacted strong prior authorization legislation in 2020 to shorten response timelines, ensure physicians are involved in decision-making, and increase transparency. Minnesota law had already included language saying that prior authorization could not be required for emergency services.

But folks at the Minnesota Medical Association were hearing that prior authorization was still getting worse for the state’s patients and physicians, with prior authorization required for a growing number of procedures and the requirements themselves becoming increasingly complex. Emergency medicine was an area where state law already prohibited prior authorization.

“We took a look at that statute and we said: OK, what else do we want to add to that? We focused on those services where when there is any kind of a delay there is a problem,” said Dave Renner, director of advocacy at the Minnesota Medical Association. “It’s a different approach to say: Let’s try to start reducing how often prior auth is being used.”?

Ultimately, Minnesota enacted legislation that prevents the use of prior authorization for the nonmedication parts of cancer care and mental health care. For a chronic condition, prior authorization does not expire as long as the treatment doesn’t change. So, a person with type 2 diabetes or rheumatoid arthritis will not need to go back and get a prior authorization every six months or every year. The exemptions are set to take effect in January 2026.

All insurers and utilization-review organizations must report to the state health department annually on how often they use prior authorization and how often they approve or deny requests. The earlier law required that insurance companies put the data on their own websites, which some companies were better at doing than others.

“This standardizes the data and allows it to be analyzed,” Renner said. “We will have a better understanding of how and when prior authorization is being used and whether that makes sense. For example, why are we requiring prior authorization for services that get approved 98% of the time? Does that result in delayed care for patients?”

The AMA advocates critical national and state-level reforms that must be made to improve prior authorization, including gold-carding programs, making prior authorization valid for the length of treatment for those with chronic conditions, and requiring that new health plans honor a previous payer’s prior authorization for a minimum of 90 days.

States aim to protect patients

Lawmakers in states across the country are making strides in reducing prior authorization burdens, as more than 90% of physicians report that prior authorization leads to care delays.

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Fixing prior authorization?

Prior authorization is costly, inefficient and responsible for patient care delays. The AMA stands up to insurance companies to eliminate care delays, patient harm and practice hassles. Learn more and become an AMA member.