Insurers and pharmacy benefit managers (PBM) use a number of approaches to cut costs, including prior authorization. Prior authorization policies require a health care provider or a plan enrollee to obtain an insurer’s or PBM’s advance approval before covering the cost of certain treatments and medications. This practice can delay access to life-saving treatments and can be applied in a manner that is inconsistent with medical standards of care.
States have introduced legislation to streamline the prior authorization process and improve patient access to treatment. Please click on the map below for state-specific information on legislation introduced this session.