Insurers and pharmacy benefit managers (PBM) use prior authorization policies to cut costs. 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 address the prior authorization process. Please click on the map below for state-specific information on legislation introduced this session.