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In Arizona, getting patient therapies approved is an out-of-date proposition

Health care will be an issue of reckoning for legislators this year. A less covered but extremely important topic is setting higher expectations in Arizona when it comes to incorporating technology into a patient’s access to care. Specifically, improving how insurers act upon prior authorization, a process required by insurance plans before certain medications are approved for patients.

Right now, most prior authorization forms are faxed, an acceptable method in 1980, but laughable in today’s high-tech world. In short, in our state getting patient therapies approved is a clunky, unpredictable and expensive proposition. Technology has vastly improved patients’ access to care and it is time that the state streamline this prior authorization process.

Currently, every insurer has its own set of forms, often different for each type of medication request, leaving physicians with piles of paperwork to fill out and to keep track of. Add to that the wait time on responses to prior authorizations, which averages from days to months.  In fact, a 2010 study by the American Medical Association found that 69 percent of doctors surveyed reported waiting several days for medication approval. Nearly all doctors surveyed by the AMA say it’s important to streamline the existing prior authorization process. Seventy-five percent say automating the systems would increase efficiencies. It is clear to see that there is huge opportunity for improving the prior authorization process in Arizona — and streamlining patients’ access to the care they need.

For further proof that change needs to happen — look at our own physician population.  Results from two independent and informal surveys conducted by the Arizona Osteopathic Medical Association (AOMA) and the Arizona Medical Association (ArMA) recently found, with more than

90 percent of those surveyed agreeing, that when it comes to prior authorizations, a new, streamlined process was important. The same respondents reported that their staffs spend 10 hours or more, up to

30 hours, a week managing and processing prior authorizations alone.

Legislation improving this process has passed in many other states. Arizona’s House of Representatives has formed an ad hoc committee to study this issue. This is a good first step. It is too soon to predict, but I suggest the recommendations should be to create one standard form; to make submissions via a computer not a fax; and to establish a predictable and uniform time frame for responses from insurers.

Such recommendations will be an antidote for both patients and physicians. Having one form will go a long way in improving the process by reducing needless duplications, a maze of paperwork and red tape for doctors and their staffs. And patients will no longer needlessly suffer for indefinite time periods, in pain and without access to the treatments they need.

In order to survive in today’s economic environment, businesses have had to simplify and streamline in order to succeed.  Physician offices are no different. That is why my hope for the new session is that leaders in the House of Representatives make an effort to innovate prior authorizations in our state, reducing administrative burdens while freeing physicians and their staffs to deliver optimal, effective care to their patients. I urge them to take this ad hoc committee steps further to streamline the prior authorization process, save physicians time and money, and help patients to live well.

— Dr. Todd Levine is board certified in psychiatry and neurology and he is co-director of the Samaritan Peripheral Neuropathy Center and director of the Samaritan ALS Clinic.

 

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