Photo: Jay Willett/ WBZ NewsRadio
BOSTON (WBZ NewsRadio) — Massachusetts Gov. Maura Healey stood side by side other state leaders on Wednesday to announce new changes to regulations on the way doctors and health insurance providers coordinate with each other.
Under previous state regulations, doctors had to get approval from a patient's health insurance plan before providing some services, medications or pieces of equipment, causing some patients to wait months for treatment. The change announced Wednesday does away with that policy, known as "prior authorization," for certain services, equipment and prescription drugs.
"If you have diabetes, you will not need prior authorization for the insulin, for the pump, for the appointment, [or] anything you need to treat this chronic illness," Healey said. "That is just one example."
Waiting months for medical care can be torturous for some patients. One woman who suffers from a neurological disease said "three months is like three years" to someone in her position.
"Why do I have to wait those three months and suffer that damage?" she said.
During a press conference Wednesday, state leaders said the previous regulations amounted to "red tape" that not only slowed down the rate at which patients received care but also gummed up the state's health care industry.
"Unnecessary paperwork and inefficiency get in the way of patients getting good care, slows down our businesses in delivering the quality of that care, and pulls people away from work, which also injures our economy," Economic Development Secretary Eric Paley said.
The move was applauded by some local health care advocacy groups. Ashley Blackburn, interim executive director of Health Care For All, said prior authorization caused delays in patient care.
“The Division of Insurance’s proposal to streamline the use of prior authorization and improve consumer protections will bring relief to patients across the Commonwealth," Blackburn said.
Some people in the health care industry say prior authorization can serve a purpose. Lora Pellegrini, president and chief executive of the Massachusetts Association of Health Plans, claimed prior authorization can even save patients money.
"Prior authorization is not merely an administrative process; it is a core affordability safeguard that promotes evidence-based care, curbs unnecessary utilization, and protects patients and purchasers from avoidable costs," Pellegrini said. "Independent analysis by Milliman finds that eliminating prior authorization in Massachusetts would increase commercial premiums by $600 to $1,500 per member annually, underscoring its essential role in maintaining affordability."
WBZ NewsRadio's Jay Willett (@JayWillettWBZ) reports.