Please Join Us Thursday, October 18 for the Next Installment in the IMS Physician Burnout Series: Breaking Down Barriers to Care
Date of Publication September 6, 2018
A recent AMA survey found that 26% of physician respondents wait an average of three business days or more for treatment authorization from insurance providers. Prior authorizations cost the average medical practice more than $68,000 per physician, per year in staff time and related expenses.
Subsequently, health plans use step therapy to refuse coverage for a specific therapy, only approving after treatment fails with a lower-cost alternative. This jeopardizes patient care and undermines physician autonomy.
The Iowa Medical Society recognizes the burden that prior authorization requirements and step therapy place on medical practices. Last year, IMS successfully championed legislation that mitigates those burdens, keeping our commitment to pursue policy changes that will help address factors that contribute to professional burnout.
The Law Is on Your Side. So Is IMS.
Iowa Code §514F.7 requires commercial plans to allow physicians to override step therapy protocols if the patient is experiencing a positive therapeutic outcome on the provider-selected medication, or if the mandated prescription medication
- Is contraindicated or will likely cause an adverse reaction or physical or mental harm
- Is expected to be ineffective based on the known clinical characteristics of the patient and the of the prescription drug
- Has been tried and discontinued due to a lack of effectiveness
We invite you to continue the conversation, which will include physicians, clinic administrators, insurance regulators, and other stakeholders. Let’s collaborate to identify even greater strategies to ease administrative barriers to care, enabling physicians to rely on their own expertise to provide patients with the highest quality care.
Mark your calendars for the next installment in the IMS Physician Burnout Series: Breaking Down Barriers to Care on the afternoon of Thursday, October 18, 2018 in Des Moines. Watch the Weekly Debrief for more details to come!