April 18, 2023
A California Medical Association (CMA) sponsored bill to reform the prior authorization process passed out of Senate Health Committee on April 12.
The bill— Senate Bill 598, authored by Senator Nancy Skinner— would require health plans to institute a one-year “gold card” prior authorization exemption for physicians who are practicing within the plan’s criteria 90% of the time. It would also grant treating physicians the right to have their appeal of a prior authorization denial conducted by a physician in the same or similar specialty.
At the committee hearing, Vivian Gonzales, a public health nurse, stood alongside her mother to give testimony about the multiple rounds of prior authorization delays her father encountered while she helped him seek treatment for metastatic melanoma.
“Time is your most precious resource when it comes to cancer, and I was spending … the last few months of my father’s life fighting with insurance companies,” Gonzales said, adding that her father ultimately passed away before he could receive radiation therapy.
“[SB 598] allows patients like my dad to get treatments they urgently need without unnecessary delays and will fix he process to allow physicians to provide treatments and services based on what we, the patients, need when we need it,” Gonzales said.
SB 598 is part of CMA’s 2023 priority bill package and builds on the momentum CMA built in the prior legislative session with a similar bill (SB 250) authored 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.