On January 2, 2020, Aimed Alliance published a report titled “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States, Survey Findings from New York.” This report, the first 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 New York. Also included in the report are recommendations for patients and health care providers to ensure that health plans are complying with the law.
The New York report’s findings include:
- Only 45 percent of survey respondents feel that the recently enacted step therapy law has improved patients’ ability to access their medications;
- Almost half (44 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 42 percent of survey respondents feel that the recently enacted prior authorization law has improved patients’ ability to access their medications; and
- About one-third (30 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.
On Dec. 24, 2019, the Times-Union featured this report in an article titled “Survey: NY providers say insurers still block, delay preferred care.” The article, authored by Bethany Bump, highlights some of the report’s findings, particularly the 41 percent of survey respondents that indicated that insurers are only meeting prior authorization and step therapy deadlines “occasionally” or “almost never.” Click here to read the article.
You can view “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States, Survey Findings from New York” here.
Part Two of this series, discussing findings from Illinois, can be accessed here.
Part Three of this series, discussing findings from Texas, can be accessed here.
Last Updated on May 15, 2020 by Aimed Alliance
