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The Business Council of New York State opposes S9651/A3789. This legislation would change the decision window for pre-authorization from 3 business days to 72 hours, it would also increase the time approved pre-authorization is valid for. The legislation also requires more disclosures and notifications on services and out-of-pocket costs. While the current pre-authorization process is not perfect, this legislation creates new challenges for both health plans and employers.
Prior authorization (or preauthorization) is an important tool designed to protect patients and ensure they receive clinically appropriate medical care from a health care professional with appropriate training. The prior authorization process protects patients from potential overtreatment and unnecessary testing, saves patients from superfluous medical costs, and allows plans to improve care coordination for patients. Without prior authorization, patients could be exposed to tests, procedures and services that are not medically necessary and may cause harm. These protections are critical to ensure a patient receives safe and effective care.
Weakening prior authorization requirements puts patients at risk and it comes with a steep price tag. Prior authorization is a process that helps ensure patients get the care that is right for them, preventing unnecessary or potentially harmful treatments. This bill would automatically extend authorizations for the life of a prescription, but it overlooks a basic reality of a patient's health changes. New medications can interact dangerously with existing ones, and a treatment that made sense at one point may no longer be appropriate. These are exactly the situations prior authorization is designed to catch. Meanwhile, New York's small and medium-sized businesses are already struggling with health insurance costs that climb higher every year. This legislation would reduce the flexibility health plans have when it comes to utilization management which would come at a cost to employers and their employees through higher premiums at a time when we are already seeing particularly high premiums.
For these reasons, The Business Council opposes the above-mentioned bill