WASHINGTON >> Reps. Mike Thompson (CA-05), Bill Johnson (OH-06), Ben Ray Lujan (NM-03), and David Schweikert (AZ-06) announced they have introduced H.R. 4841, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, which is designed to improve access to prescription medications for Medicare beneficiaries.
“This legislation is another step toward modernizing Medicare and making it work better for patients,” said Thompson. “By standardizing the way electronic prior authorization systems operate under Medicare—ultimately mitigating delays for seniors needing prescriptions— we can greatly improve efficiency and patient experience. I’m proud to sponsor this bipartisan bill and I’ll continue to work to help bring Medicare into the 21st century.”
A number of medications require approval by a health insurance plan prior to dispensing in order for the plan to cover the medication, a process known as prior authorization (PA). Should a PA not be obtained prior to dispensing, the patient is faced with the choice of waiting for a PA or paying for the medication out-of-pocket.
The representatives supporting the measure consider traditional PA process uses outdated modes of communication, which can be burdensome for the provider and pharmacist and often causes undue delays for the patient.
“I joined a bipartisan group of my House colleagues in introducing legislation that will improve access to prescription medication for Medicare beneficiaries. This bill would improve the outdated and inefficient prior authorization (PA) process and allow patients to obtain needed prescription drugs without unnecessary delay,” said Johnson.
Electronic Prior Authorization (ePA), which has seen widespread and successful adoption in the commercial market, automates the process by streamlining communication among providers, payors and pharmacies. This bill would encourage the use of ePA by creating system standards under Medicare, thereby promoting adoption by Medicare providers and bringing appropriate treatments to seniors faster.
“Too often the prescription authorization process for those enrolled in Medicare is lengthy, confusing and frustrating,” said Lujan. “The purpose of our bill is to streamline the process, eliminate frustrating delays and allow seniors to get the prescriptions they need with a minimum of fuss,” said Lujan. “By standardizing the electronic prior authorization system, our legislation makes Medicare easier for seniors. That’s good for patients and ultimately good for ensuring the Medicare system operates as cost efficiently and effectively as possible.”
