Health advocacy groups urge legislators to streamline patient access to meds

Staff Report

SPRINGFIELD, Ill. — Wednesday, Feb. 5, the Illinois House Human Services Committee will take up a bill designed to standardize the hundreds of different forms used by insurance companies to authorize medical treatment.

Health advocacy organizations from around the state are urging the Illinois General Assembly to support House Bill 3638, sponsored by state Rep. Laura Fine, D-Glenview, and Senate Bill 2585, sponsored by state Sen. Dan Kotowski, D-Park Ridge, and state Sen. Mattie Hunter, D-Chicago, to ensure prompt patient access to life-saving medications by streamlining the prior authorization process in the state — a process where patients must wait until the insurance company approves the use of a medication recommended by their physician. It has meant mounds of paperwork for doctors and nurses, and days, even weeks, of delays for patients seeking critical care.

According to a 2010 American Medical Association survey on prior authorization, physicians and staff spend about 20 hours per week, on average, dealing with prior authorizations. In Illinois alone, there are more than 300 different forms used by various insurance companies for prior authorization, which, according to health care providers, is causing alarming, even dangerous, delays in access to medication.

“The prior authorization process can absolutely have an impact on the health of our patients,” said Nancy Leone, a registered nurse in Antioch, Ill. “Recently, a patient needed a specific type of chemotherapy for abdominal cancer. It was denied by the insurance company, and then it took about a month of waiting and back and forth before the patient was finally approved and could receive it.”

At least 20 Illinois health advocacy organizations, representing tens of thousands of patients, have sent a letter to the Illinois General Assembly supporting H.B. 3638 and S.B. 2585 and stating, in part:

“Standardization of prior authorization should be part of Illinois’ efforts to improve health care and reduce costs, as it has clear implications for improved efficiency and enhanced patient outcomes. As organizations that represent a wide variety of patients, we urge you to support legislation that would standardize the state’s prior authorization system.”

Organizations include AIDS Foundation of Chicago; American Cancer Society-Cancer Action Network; American Heart Association/American Stroke Association; American Lung Association of Illinois; American Nurses Association of Illinois; Chicago Hispanic Health Coalition; Epilepsy Foundation of Chicago; Epilepsy Foundation of North Central Illinois, Iowa and Nebraska; Epilepsy Foundation of Greater Southern Illinois; Epilepsy Therapy Project; Gateway Hemophilia Association; Gilda’s Club of Chicago; Illinois African-American Coalition for Prevention; Illinois Psychiatric Society; Illinois Rural Health Association; Illinois Society for Advance Practice Nursing; Leukemia and Lymphoma Society-Gateway Chapter; Leukemia Lymphoma Society of Illinois; Lupus Foundation of America-Illinois Chapter; Mental Health America of Illinois; NAMI Greater Chicago; and State Pain Policy Action Network.

“There have been times when I’ve had to wait for up to three weeks after requesting my prescriptions, because the doctor must fill out any number of forms and wait for approval from the insurance company,” said Columbia resident and arthritis sufferer Kim Kitowski. “Access to medication is critical to my ability to go to work, care for my twin boys — live my day-to-day life.”

H.B. 3638 and S.B. 2585 would amend the Illinois Public Aid Code and the Illinois Insurance Code and require the Department of Healthcare and Family Services and the Department of Insurance to jointly develop a uniform prior authorization form for prescription drug benefits on or before July 1, 2014.

“Pain remains one of the most feared and burdensome symptoms for cancer patients and survivors, and waiting for prior authorization approval can have significant negative impacts on a patient’s treatment and quality of life,” said Heather Eagleton, director of public policy and government relations of the American Cancer Society-Cancer Action Network. “When a person has a disease like cancer, they need to be focusing on getting better and fighting the disease, not administrative barriers to care.”

From the Feb. 5-11, 2014, issue

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