HARRISBURG – The PA Senate approved legislation that streamlines the prior authorization and step therapy processes for medical treatment. Senate Bill 225, sponsored by York County Sen. Kristin Phillips-Hill, would set standards for commercial insurance plans and Medicaid plans when seeking prior authorization approval, as well as step therapy protocols. Prior authorization refers to any process by which health care providers must obtain advance approval from a health plan before a specific procedure or service is delivered to a patient to qualify for payment. The process was created to control costs for experimental or new procedures. Step therapy requires patients to try one or more prescription drug treatment options chosen by the patient’s insurance provider. Insurers would be required to provide timely approval for both non-urgent and emergency health care services to health care providers before services and treatment are rendered. It also spells out guidelines for prescription drug step therapy, and options for patients and health care professionals to obtain an exception to best serve the patient and their treatment plan. The bill now goes to the PA House.
SEN. KRISTIN PHILLIPS-HILL