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 Health Can’t Wait AcHtieoanltDhaCyanin’tLWaanistinTaglking P
RefInosrumranicnegcopmrpioanrieas ucotnhtionureiztao teisocnaladteethneiauslesof prior a and step therapy in the name of cost savings but it is leadin
and step therapy delays for patients
delays for patients and growing administrative burdens for Opatients, physicians, and health providers. Below are some statistics and talking points to s
Health Can’t Wait is a coalition of care providers dedicated to
tive advocacy efforts.
HealthCan’tWaitAct,legislationthatreformGspErioNr ERALOVERVIEW:
n January 30, the Michigan Senate Health Policy
putting Michigan patients first andendainngddHelauymsainpSaetrievnictse’sCommitteehearingroom access twoahseafilltlhedcabrey: supporters of Senate Bill 612, the
American Autoimmune Related
Impact on Patient Care
authorization and step therapy practices — policies
Diseases Association
insurance companies use to slow, and sometimes deny,
American Cancer Society Cancer • These practices can prevent patients from receiving the care
and/or provider have deemed is necessary.
life-saving health care.
Action Network
AmPeartiiceantsC,opllheygseicoifaCnasrdainodlogayd,vocates, including the
Michigan State Medical Society (MSMS) President-Elect S.
MI Chapter • Physician/provider judgment is undermined – why is approva
American College of Physicians,
physician prescribed the treatment and the patient is paying f
Bobby Mukkamala, MD, testified in support of . The bill is
MI Chapter
sponsored by state Sen. Curt VanderWall, who serves as
American Diabetes Association
insurance plan that covers it?
Patient care can be delayed anywhere from a few hours to a f
chairman of the Senate Health Policy and Human
American Medical Association
Services committee.
Berrien County Medical Society
o In a 2018, American Medical Association (AMA) survey o transparency, clinical validity, and fairness requirements cians, 91 percent reported care delays associated with p
The Health Can’t Wait Act would introduce new
Epilepsy Foundation of Michigan Genesee County Medical Society
to prior authorization and step therapy practices,
Hemophilia Foundation of MI
empowering physicians to override step therapy protocoltsion Henry Ford Medical Group
Huron Valley Physicians • It impacts quality of care as patients who are frustrated with The act would also require insurers to base their prior
when they consider it not to be in a patient’s best interest.
confusing process may simply abandon the treatment
authorization requirements on clinical, evidence-based
Ingham County Medical Society
criteria established with input from practicing physicianos. In a 2018, AMA survey, 75 percent of respondents repo Jackson County Medical Society
Kent County Medical Society
lead to treatment abandonment.
• According to a recent AMA physician survey, nearly a third of
The Health Can’t Wait Act would also establish:
Macomb County Medical Society
• Transparency – Insurance company prior
MI Academy of Family
ported that prior authorization led to a serious adverse event
authorization requirements will be published on
the insurer’s website in detail and in easily
MI Coalition for Affordable
understandable language.
MI Council for Maternal and Child
Administrative Burden
• Clinical validity – Adverse determinations and
Healthdecisions on appeals must be made by •a phyPsirciioanr authorization and step therapy processes lead to uncom
MI Physical Therapy Association
for physicians and staff, which translates into increased over MI Psychiatric Society practices – many of which are already financially stretched.
in the same specialty as the service being
MI Podiatric Medical Association
requested. Medical directors of insurance
companies must be licensed to practice medicine
• Prior Authorizations cost $2,161 to $3,430 annually per FTE p • Fairness for patients – Urgent and non-urgent prior
MI Radiological Society
MI Rheumatism Society
• Interactions with insurers cost $82,975 annually per physicia
authorization requests must be acted upon by
MI Society of Anesthesiologists
insurers within 24 and 48 hours, respectively.
• More than 1 in 3 physicians have staff who work exclusively Please visit to share your TODAY AND SUPPORT SB 612.
MI Society of Eye Physicians and Surgeons
MI Society of Hematology &
prior authorization or step therapy delay stories and ask
your lawmakers to support Senate Bill 612. • • MI Society of Interventional
Pain Physicians
MI Society of Pathologists
Health systems and hospitals employ armies to work just on
MI State Medical Society
• Physicians and their staff spend an average of almost two bu each week completing prior authorization requests.
Washtenaw County Medical Society BULLETIN JANUARY / FEBRUARY / MARCH 2020
• These onerous requirements not only drive up costs to the pr
but they lead to disruptions in practice workflow, resulting in and a reduction in physician time spent providing care to pati
Muskegon County Medical Society
National Multiple Sclerosis Society, MI Chapter
Oakland County Medical Society Saginaw County Medical Society
tion. Henry Ford Health System employs more than 100 FT pe
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