Bill aims to end insurance practice of prior authorization

Assembly Minority Leader Jon Bramnick introduced a bill Tuesday that would ban mandated pre-approvals for tests, treatments and prescriptions normally covered by medical insurers. An American Medical Association survey of 1,000 doctors taken in 2016 found, on average, 20 percent waited up to five days for preapproval decisions — 6 percent even longer. After a news conference, Bramnick introduced NJTV News to a woman with Stage 4 colorectal cancer who is currently waiting for preapproval for an MRI. The woman wished to remain anonymous.

“I’m waiting for the MRI, which is next week. Depending on the outcome of that is whether I’m a candidate for surgery. And this has been going on, I’ve been going to treatment for a year and a half, so it’s frustrating,” she said. “I think it stinks. I mean, if you have stage 4 rectal cancer, I’m not getting the MRI just because I have nothing else to do. I mean, what has to be approved?”

Bramnick believes that the doctor’s prescription should be all the approval a patient needs.

“It’s tough enough to deal with bad diagnoses. Why do you have to deal with middle managers at insurance companies to get the care? These doctors have gone to medical school. They are the ones who determine what type of care you need, what kind of tests you need, what kind of medicine you need, not the middle manager and insurance company,” Bramnick said.

Ward Sanders from the New Jersey Association of Health Plans weighed in.

“Prior authorization serves an important patient-safety role and can protect patients from things like harmful drug interactions since doctors don’t always know what other drugs a patient may be taking. It also protects against diversion, fraud, waste and abuse,” he said.

The bill will now be referred to committee.