Academy meets with HHS Secretary Price on burden of prior authorization

In June, the Academy joined a small delegation of medical organizations to meet with Secretary of Health and Human Services Tom Price and CMS Administrator Seema Verma to discuss ways to alleviate the regulatory burdens physicians face. Member to Member discussed the meeting with Colby Evans, MD, chair of the Academy’s Drug Pricing and Transparency Task Force.

Member to Member: What were the prior authorization messages discussed with HHS Secretary Price and CMS Administrator Verma?

ColbyEvans.jpgDr. Evans: The main message was that drug prior authorizations are a substantial and increasing burden on patient care. Prior authorizations are preventing patients from getting treatments and they are delaying treatments. Often this is happening without any obvious benefit to anyone.

We were joined at the meeting by the American Osteopathic Association, Alliance of Specialty Medicines, American Dental Association, American Psychiatric Association, American College of Cardiology, American Society of Clinical Oncology, and American College of Radiology. A number of the other medical organizations at the meeting acknowledged that they share our concerns.

This issue is already problematic and it’s getting worse.

In a 2016 Academy survey of AAD members and Association of Dermatology Administrators & Managers members, the majority of respondents agreed that they have seen an increase in the number of drugs requiring prior authorizations and the subsequent delays in patient treatment.

M2M: At the meeting, the Academy shared the results of a 2016 Drug Prior Authorization Survey, which demonstrated the enormous burden prior authorizations have on practices. What were the key findings of the survey shared at the meeting?

Dr. Evans: The survey was done by the Academy’s Drug Pricing and Transparency Task Force to assess where we stand with prior authorizations in dermatology. In early 2016, the Academy sent surveys to 208 AAD members and 500 Association of Dermatology Administrators & Managers members. We found that prior authorizations are consuming hours of physician and staff time on a daily basis. That’s staff time that should be spent on patient care.

Although we do see expensive medications like biologics on the list of medicines to frequently require prior authorization, we also increasingly are seeing generic older and less expensive drugs requiring prior authorization.

This is becoming an increasing barrier to care. When you can’t even use an inexpensive generic medicine without extensive paperwork and waiting for days or weeks for approval, it becomes difficult to treat the patient at all.

We asked the respondents of our survey to propose meaningful options to help change the burden. Suggestions included a standardized form to use across all insurers and pharmacy benefit managers (PBM) and preventing the need to reauthorize medicines. For example, if a patient gets approved for a medicine, but then changes jobs and gets new insurance, they might need to go through the prior authorization process again to get the same medication that was already approved.

The Academy has developed a tool that allows members to easily generate prior authorization letters for patients. ACCESS THE TOOL.

There also were suggestions to shorten the turnaround time for prior authorization decisions, as well as to lengthen the period the prior authorization covers.

We recognize that we’re not going to eliminate prior authorization, though that would be the best solution. We’re trying to put some fairness into the process so that the patient comes first. We encouraged Secretary Price and Administrator Verma to lift this burden by streamlining the Medicare Advantage and Medicare Drug Benefit plans drug prior authorization requirements.

M2M: How did Secretary Price respond to the meeting and the Academy's requests?

Dr. Evans: The response was very positive. They showed a strong interested in the fact that we presented data. We spent the time to acquire the information they could use to help make decisions. For example, our survey showed that on average our physicians are doing six prior authorizations a day, taking up to three hours a day. We used that data to show how much time that’s consuming.

Secretary Price showed a particular interest in wanting to help physicians focus on patient care and not be limited by bureaucracy or regulations. He was clear that the Department and its agencies are reviewing every single rule and regulation to find opportunities to reduce the burden on physicians. He and Administrator Verma noted that they found it disturbing that physicians reported their concerns were not heard, and explicitly invited us to engage with them, and to be as specific as possible in our requests.

Our presentation dovetailed very effectively with that goal of trying to streamline the process.

M2M: What can dermatologists do now to lessen the burden of prior authorization?

Dr. Evans: I urge all Academy members to use the new tool on on the Academy's website that allows you to generate prior authorization letters quickly and easily.

I also encourage dermatologists to get involved in advocacy through the Academy and through their state societies, with the goal of seeing changes in regulations at state and national levels.

We’ve seen a lot of advocacy success in the realm of step therapy. We’ve seen laws passed in several states that limit step therapy and level the playing field for patients. The legislative and regulatory bodies are interested in hearing from us on streamlining the process and improving patient care.