CA Assembly Bill 1268 – Prior Treatment Authorization For Cancer Patients

For some time now, I have been writing about and sharing information about the effects that prior authorization regulations have had on cancer treatments. For a patient, when a treatment is not authorized in a timely manner, the delay can affect the outcome and may even be a factor in long-term survival. And some delays have been so great that the treatment ultimately has to be abandoned. In addition, the stress caused by delays not only affects that patient but also their family members and/or other caregivers and supporters as well.

For those of you who are not CA residents but who are having similar issues in getting prior treatment authorization, whether for cancer or any other disease, you may want to review this initiative as well and begin a similar effort in your State.Barbara Jacoby

And it is not unusual for the lack of authorization to become yet another factor with which the patient has to deal since it is their insurance company that is affecting the outcome. So often the patient has to literally spend hours of effort in trying to either resolve the issues or find other ways in which they can get access to the treatment that the medical team has determined to be what is the best for them.

But, those affected at the first level of this controversy are the oncologists and other medical team members who are having to find ways to get approvals for those treatments that they have determined are the best for their patients. Prior authorizations usually include numerous phone calls, faxes, emails, etc. and these options do nothing to improve the level of care for patients and increase the costs and administrative burdens placed on physicians and their staffs. Research has shown that this averages a full two work days worth of time that is needed to do just this work. This is just one more factor that has added to the burden that has already been created by electronic health record keeping that is resulting in physician burnout.

That is why I wanted to share the information about the CA bill, AB 1268, that is coming up for discussion at the Assembly Health Committee this coming Tuesday, April 2, 2019. Very little information has been collected regarding the application of prior authorization processes, their approvals and their denial rates of healthcare services by insurers. This current proposal is designed to create a streamlined authorization system by collecting data on approval rates and the range of services that require prior authorization by plans. This data would then be used by health plans and insurers to self-govern themselves by taking the information they will be reporting to the regulator into account when updating their prior authorization criteria.

I have included the Fact Sheet provided on this legislation. Additionally, the full amendment to Health and Safety Code, and to amend Section 10123.135 of the Insurance Code has been included here for your review, if you wish to review it. And a Sample Support Letter Download has also been provided if you wish to request that your local CA legislator support this piece of legislation.

For those of you who are not CA residents but who are having similar issues in getting prior treatment authorization, whether for cancer or any other disease, you may want to review this initiative as well and begin a similar effort in your State. It is past time for all of us to do everything that we can to assist our patients and their doctors to be able to access the treatments that have been recommended by the professionals who are in the very best position to make those determinations at the top level.