Thanks to a new law that took effect in July, providers across Oregon can now submit one standard form to request prior authorization for prescription drug coverage instead of muddling through hundreds of forms.
The new law, which was passed in 2013, means insurers have to accept a state standardized form rather than use their own forms, which caused time and headaches for providers.
“This might not seem like much but we counted more than 200 separate forms that insurers require Oregon providers to fill out when requesting authorizations so the patient may have needed diagnostic tests, prescriptions, durable medical equipment or access to a specialty physician,” Sen. Alan Bates, D-Medford, said before the bill passed in 2013. “I figured my clinic staff spends between 20 to 30 percent of our time managing insurance approvals and dealing with insurers, and it’s an incredible impediment to patient care.”
A survey by the American Medical Association of 2,400 doctors found prior authorization processes pose problems, and that “Preauthorization requirements not only are a source of frustration for physicians, but they also create delays that interfere with patient care.”
Although the new form took effect in July, Dianne Danowski Smith of Publix Northwest, said many physicians don’t realize they have an option and might still be filling out more paperwork than they need to.
Jake Sunderland, public information officer for the Oregon Department of Consumer and Business Services, said the new law is going well for insurers. The department had one internal issue with a provider being denied when they submitted the standardized form shortly after the law took effect but otherwise it’s been a smooth transition.
“We haven’t really heard of any issues since, which is a great sign,” he said.
Providers can still complete multiple forms but insurers must accept the standardized option.
“Which hopefully speeds this up,” said Sunderland, making sure no one is rejected.
All healthcare payers must accept the form, including insurers, prepaid managed care organizations, third party administrators, entities that establish self-insurance plans, healthcare clearinghouses, and other entities that perform claims processing and other administrative functions.
The requirements apply whenever a plan requires prior authorization for a prescription drug, regardless of whether the drug is covered under the plan’s medical or pharmacy benefit, Smith said.
Shelby can be reached at [email protected].
