PAMED Applauds the Passage of Prior Authorization Reform in Pennsylvania

Last Updated: Oct 26, 2022

Today, we celebrate the final passage of Senate Bill 225 on prior authorization reform; a bill that can be considered the most comprehensive patient protection bill passed by legislature in two decades.

PAMED President, Dr. David A. Talenti said, “The passage of prior authorization reform is a huge win for the medical community but more importantly, for our patients. PAMED has stayed the course over the last 6 years and worked vigorously to negotiate with a broad coalition of stakeholders who made their voices heard. This bill is a substantial improvement to health care in Pennsylvania and I applaud it.”

While the final bill does not eliminate prior authorization, it provides standardized parameters that govern the relationships between patients, providers, and insurers in making health care coverage decisions.

This amendment differs from the original bill passed by the Senate and includes clear agreed-to language standardizing timeframes, addressing needs for Medication Assisted Treatment, sharpening transparency in medical policies, notices, and data collection requirements as consumer protections. It also more appropriately combines external appeal provisions and the inclusion of Medicaid managed care plans.

In summary, the bill reduces paperwork and administrative time for providers. Special thank you to Senator Kristin Phillips-Hill and Representative Steven Mentzer for championing this bill. The bill now heads to Governor Wolf to be signed into law. 

Thank you to our broad coalition of providers, patient advocates, hospital and state regulatory agencies:

3 comments

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  1. William Wenner | Oct 27, 2022

    Would someone be so kind as to direct me to an analysis of the components of the bill, how it will impact the practice of medicine?

    I pulled the PDF of the bill.  The first 49 of 168 pages are line outs of the previous legislation.  The next 20 are definitions.  It is quite labyrinthine. 

     

  2. Mark Austerberry | Oct 27, 2022
    Prior authorization was certainly a pain point and navigating that system was quite a process …… now physicians can provide timely and appropriate care for their patients….....Thanks again to the hard work of PAMED and our grassroots physician members!  
  3. Robert E. Wenger | Oct 26, 2022

    Kudos.  This will free up professional time to allow for greater access to medical care.  However, you do not address the mechanism by which prior authorization will be contained or appealed.

    Now we must regulate the PBM (patient benefits manager) who for too long have denied and disrupted our recommendations for our patients' treatment plans.  

     

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