March 07, 2023
When insurance companies get between patients and physicians, patients get sicker and health care becomes more expensive. That is why the California Medical Association (CMA) is sponsoring legislation to reform the prior authorization process, which will result in less time spent on administrative work, increased access to necessary care for patients and a restoration of the physician-patient relationship in medical decision-making.
Senate Bill 598, authored by Senator Nancy Skinner, takes a wholistic approach to reforming the prior authorization process by requiring plans to create exemption programs that allow physicians who are practicing within the plan's criteria 90% of the time to receive a one-year exemption from the plan's prior authorization requirements.
Additionally, the legislation will give a treating physician the right to have an appeal of a prior authorization denial conducted by a physician peer of the same or similar specialty. This will help to streamline the appeal process, and make certain that patients are receiving timely access to medically appropriate care.
SB 598 builds on the momentum CMA had last year with a similar bill (SB 250) championed by then Senator Richard Pan, M.D.
Share Your Story
You can help CMA advocate for SB 598 by sharing your story with us! We want to hear from patients and physicians who have experienced delays in care because of the broken prior authorization process. Click here to add your voice to help reform the prior authorization process to ensure that patients receive the care they need — when they need it.