Change could reduce time Iowa patients wait for prescriptions

CEDAR RAPIDS - Health care advocates are encouraged by new legislation Gov. Terry Branstad signed into law Thursday that requires Iowa insurance companies to respond more quickly when physicians seek authorization before prescribing certain medications.

'Commons sense tells us the sooner a patient gets the right medication, the quicker he or she gets on the road to better health, which saves insurance companies money in the long run,” said Dale Todd of Cedar Rapids, legislative chairman for the Iowa Epilepsy Foundation.

The law will require insurance companies to respond to 'prior authorization” requests within 72 hours for urgent cases and five calendar days for non-urgent cases.

Insurers often require prior authorization for certain types of medications or treatments not routinely covered, such as brand-name medicines that have a less costly generic alternative.

It also is required for prescriptions of high-priced medications; drugs not usually covered but said to be medically necessary. Also, it includes drugs normally covered but being used in higher than normal dosages.

'Insurance companies want to know that (the prescription) is appropriate …

that there isn't a cheaper alternative, for example,” said Scott Sundstrom, who lobbies for the Federation of Iowa Insurers, which was registered as 'undecided” on the bill.

Todd and Threase Harms of Des Moines, who lobby for AstraZeneca Pharmaceuticals as well as Easter Seals, the Epilepsy Foundation, National Multiple Sclerosis Society and the Brain Injury Alliance of Iowa, have heard stories of patients waiting weeks, months or more than 100 days for authorization.

Delaying authorization - and treatment - can exacerbate a situation, Todd said. In the case of epilepsy, it can result in increased seizure activity and hospital stays.

The advocates suspect delaying authorization has been a cost-containment strategy for some insurance companies. 'I'm sure (insurance companies) would say something different,” Harms said, 'but that's one school of thought.”

Sundstrom has heard those stories, too, but when the issue of delays came up in a legislative subcommittee meeting, the Iowa Insurance Division said it had received no such complaints.

The law, House File 632, is a compromise that went through several modifications on its way to passage. Similar legislation was passed in 2014, but Branstad vetoed the bill at the request of insurance companies, Todd said.

Insurers didn't ask the governor to veto HF 632, Sundstrom said.

They did have a concern that advocates' insistence on a five-calendar-day response may result in more delays. That's because an insurer who receives a prior-authorization request on a Tuesday ultimately may deny it because it may not be able to process it before the weekend.

In that case, the patient would have to resubmit the request.

Rep. Linda Miller, R-Bettendorf, one of the lawmakers who pushed for the changes, said lawmakers' 'expectation is that insurers be prompt.”

'Insurance companies don't like it because they feel like they need flexibility, and they don't want us to be prescriptive,” Miller said.

Medicare and Medicaid turn around most prior authorization requests in 24 hours, she said.

HF 632 was 'a consumer transparency issue,” Miller said. 'It's good public policy for people to have their prescriptions filled and if not, they should know why.”

The effect of the changes will be limited, Sundstrom said, because only one-third to 40 percent of Iowans are in the state regulated insurance market. The others are covered under federally regulated plans or Medicare and Medicaid.

For the most part, the changes apply to individuals who buy insurance on their own, not as part of an employment-based plan, and people employed by businesses with fewer than 100 employees.