On January 9, 2020, Aimed Alliance published a report titled “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States, Survey Findings from Illinois.” This report, the second installment of a three-part series, is based on a recent survey commissioned by Aimed Alliance. It gauges the degree to which health plans are complying with recently enacted prior authorization and step therapy laws and whether states are doing enough to enforce those laws. The report discusses the findings of Aimed Alliance’s survey of health care practitioners in Illinois. Also included in the report are recommendations for patients and health care providers to ensure that health plans are complying with the law.
The Illinois report’s findings include:
- Only 22 percent of survey respondents feel that the recently enacted step therapy law has improved patients’ ability to access their medications;
- Over half (58 percent) of survey respondents indicated that health plans are requiring patients to try and fail on a medication that they have already tried “every time” or “most times,” even though the law requires health plans to grant a step therapy exception in these situations;
- Only 28 percent of survey respondents feel that the recently enacted prior authorization law has improved patients’ ability to access their medications; and
- About one-third (33 percent) of survey respondents indicated that health plans are requiring prior authorization in emergency situations “every time” or “most of the time,” even though the law prohibits this.
You can view “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States, Survey Findings from Illinois” here.
Last Updated on May 15, 2020 by Aimed Alliance
