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New Jersey passed a law that will have insurance companies approving meds faster

MARY LOUISE KELLY, HOST:

Imagine you're sick and your doctor prescribes a drug, but the insurance company will not approve the treatment. In the meantime, you can't get the medicine you need, sometimes for weeks. This process is called prior authorization, and New Jersey recently passed a law to make it faster. From member station WHYY in Philadelphia, Alan Yu has more.

ALAN YU, BYLINE: Sandra Johnson started feeling short of breath a few years ago. Sometimes it really limited what she could do.

SANDRA JOHNSON: Getting up to walk from my bedroom to the bathroom, I will be so out of breath that I would have to just sit to prepare myself to get up to take a shower.

YU: Her doctor diagnosed her with severe persistent asthma and prescribed an injectable drug. Her insurance company approved it. The medicine made a difference. Johnson, who lives in Plainfield, N.J., could go back to her job, do chores, go grocery shopping again. But then her insurance company required prior authorization again. This time, the answer was no, and Johnson has been without her medicine for months. This is a common problem, says Tina Shah, a pulmonary and critical care doctor in Newark, N.J.

TINA SHAH: This causes so much moral distress that I often go home and I have to decompress because I know that I can be the best doctor, but because of prior authorizations, I often can't deliver the best care.

YU: More than 90% of doctors said their patients have had to delay their health care because of prior authorization, according to a 2022 survey by the American Medical Association. A third of the doctors in that survey said the delay led to serious problems for their patients, even a life-threatening event. A new law that was passed in New Jersey aims to address those issues and speed up the process. Once it takes effect next year, health insurance companies have to decide on prior authorization within three days. If a doctor says their patient needs medicine urgently, the insurance company has to approve or deny within 24 hours. Shah says this legislation is something that doctors, nurses and patients have wanted for a long time.

SHAH: It's going to be a huge difference and allow me to do what I actually trained to do, which was spend time with my patients and try and make them feel better.

YU: Ward Sanders represents the health insurance companies. He's the president of the New Jersey Association of Health Plans. He says it's good that the law requires faster decisions, but he also says that prior authorization is not just red tape. The process is in place for a reason.

WARD SANDERS: The goal of prior authorization is to provide the right care at the right time and the right setting and to allow for the efficient allocation of resources.

YU: For example, by asking doctors to consider cheaper drugs that achieve the same therapeutic effect. He pointed to a line in New Jersey's state budget documents last year, saying that prior authorizations saved the state health insurance program for public employees almost $100 million. This debate will continue. Washington state was the first to pass this kind of legislation, but there are more than 20 states with similar bills going through the legislative process.

For NPR News, I'm Alan Yu. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Alan Yu | WHYY