HARRISBURG – Legislation is headed to the governor that reforms prior authorization and step therapy for medical treatment. York County Sen. Kristin Phillips-Hill’s measure would create standards and timely feedback for commercial health insurance and Medicaid plans, when health care providers seek prior authorization approval. The bill also reforms step therapy protocols. Prior authorization is the process in which health care providers obtain advance approval for purposes of payment coverage and reimbursement from an insurer before a specific procedure or service is delivered to the patient.The legislature, through Senate Bill 225, standardized the process and shortened time frames to provide for much more rapid approval. Step therapy is another form of prior authorization; however, it applies to prescription drug treatment plans. Insurers may recommend different drug treatment options to patients in an effort to address costs. Health care providers argue this ultimately delays treatment plans and often leads to patients walking away from treatment all together.
SEN. KRISTIN PHILLIPS-HILL