To help patients, Dr. Edgerton points to the work of the ACR in speaking out about onerous cost mitigation strategies, such as step therapy and prior authorization. Example: The ACR is supporting legislation to modernize prior authorization to ensure it becomes standardized and supports electronic options, requires insurance to be transparent about coverage restrictions and eliminates prior authorization for the therapies that are most often approved.
The ACR also continues to advocate against step-therapy that does not put patients first. Legislation currently supported by the ACR regarding step therapy recommends a clear and transparent process for patients to seek exceptions to step-therapy in certain cases, as well as establishes a reasonable and clear timeframe for override decisions that take into account the patient’s medical history and the provider’s expertise before denying a patient medically necessary treatment.
Carina Stanton is a freelance science writer based in Denver.
Additional Resources
Visit the ACR’s Legislative Action Center to follow current bills and share your patient’s financial challenges with step-therapy, prior authorization and other financial concerns with insurance coverage.
