Want to see a doctor perspire? Bring up prior authorization at your next visit.
Little frustrates doctors as much as these restrictions by insurers that second-guess their judgments and require them to fill out paperwork to OK certain high-cost procedures and prescriptions.
Of course, in an era of skyrocketing health care costs, insurers have viewed prior authorization as a necessary check to doctors who have little financial incentive to order lower cost alternatives — even when they are equally effective. It was an effective deterrent in Minnesota over the past decade, for example, to prevent overuse of high-tech imaging scans.
But fed-up doctors are hoping to make 2015 the year when state lawmakers get involved in setting limits on prior authorization with respect to prescription medications.
Patient care can suffer, because the restrictions can often result in delays or switches in medication prescriptions, said Dr. George Schoephoerster, a St. Cloud geriatrician. “We’re all annoyed by how this affects our practices. It’s a significant cost [for doctors] to address prior authorization … but our bigger concern is the impact on patients.”
Schoephoerster has led efforts by the Minnesota Medical Association, the trade group representing doctors, to address the issue. The association teed up prior authorization as a legislative issue by making it the cover story of its latest issue of Minnesota Medicine magazine. And doctors will be meeting this week to discuss legislative requests for the upcoming session.
One idea is some sort of public comparison of health plans by their prior authorization restrictions. It’d be a delicious turning of the tables for doctors, because insurers have helped create the transparency movement in health care that has led to ranking doctors on everything from how much they charge to whether they prescribe excessive antibiotics or persuade their diabetics to stop smoking.
Schoephoerster contends that insurers have gone too far with prior authorization following their success in using it for imaging and other high-cost areas of health care.
Looking at one plan each from six major health plans in Minnesota, the association found 1,036 drugs subject to prior authorization restrictions. But only six drugs were restricted by all six insurers.
While some were high-cost drugs such as Remicade for rheumatoid arthritis, Schoephoerster said others were lower-cost drugs that didn’t seem to need restrictions.
“Docs do need to be value conscious,” he said, “but the issue is, are [the restrictions)]saving money for the insurance company, or are they saving money and improving care of the patients.”