Committee hears extensive testimony on bill to curb prior authorization delays in Nevada

Assemblymembers and health-care witnesses debated a bill aimed at reducing prior authorization barriers that doctors say delay care and harm patients.

Assembly Bill 463, sponsored by Assemblymember Shay Backus, would revise state laws governing prior authorization by specifying categories of care that insurers cannot require prior authorization for, setting timelines for insurer responses, and creating provider-exception pathways and deemer provisions when insurers fail required processes. The sponsor and physician witnesses told the committee the current prior-authorization process causes dangerous delays; insurers and managed-care groups warned a broad removal of prior authorization could raise costs and risk patient safety.

"Prior authorization has really become the bane of our existence, and unfortunately, it's the bane of our patients' existence," said Dr. Joseph Adeshek, president of the Nevada State Medical Association and a board-certified maternal-fetal medicine physician in Las Vegas. He told the committee that routine supplies and pregnancy medications are often subject to repeated denials and lengthy peer-to-peer fights that delay treatment.

Assemblymember Shay Backus framed the bill as drawn from the American Medical Association model language and provisions other states have enacted. She described a revised amendment that trims and deletes some sections and noted that the measure touches both private insurance law (chapters of the Nevada Revised Statutes governing insurance contracts) and Medicaid/CHIP provisions (NRS chapter 422). She said the amendment narrows some mental-health language after stakeholder discussions and inserts a list of evidence-based preventive services that would not require prior authorization, modeled on U.S. Preventive Services Task Force A and B recommendations.

Multiple specialty societies and providers testified in support. Leah Cartwright of the Nevada Psychiatric Association said the group supported the bill and tied prior-authorization delays to cases reviewed by child-death review committees. "In 2018, the Clark County Child Death Review Committee brought forward two cases of children who had died because their medications were not approved," she said. Multiple oncology, obstetrics and other specialty groups, including the Nevada Osteopathic Medical Association and Comprehensive Cancer Centers of Nevada, also voiced support.

Individual physicians gave specific examples: Howard Baron, a pediatric gastroenterologist, described biologic medication authorizations for children with inflammatory bowel disease that were delayed for months, contributing to hospitalizations. Catherine Nielsen, a parent of a child with type 1 diabetes, described insurance refusals that forced her hospitalized daughter to try and fail other insulins and the ongoing difficulty obtaining test strips and pump supplies.

Insurers and managed-care groups testified in opposition or raised concerns. Shelly Capuro of the Nevada Association of Health Plans said the association was concerned with a blanket removal of prior authorization for complex services such as outpatient mental-health and substance-use disorder treatment, cancer therapies and pediatric hospice, saying the process is used to confirm medical necessity, follow evidence-based guidelines and limit fraud and abuse. Paul Young, representing the Pharmacy Benefit/Managed Care Association (PCMA), warned the panel that eliminating prior authorization broadly could increase costs by encouraging use of more expensive nonformulary medications.

The Division of Insurance provided neutral comments and suggested clarifying language on a "deemer" provision that deems a prior-authorization request approved if the insurer violates certain statutory requirements. Adam Plain, testifying for the Division, suggested clarifying whether a violation must be adjudicated in an administrative hearing or court to trigger deeming. He also recommended that the effective-date language reference policies "issued or renewed on or after" 01/01/2026 to avoid gaps in timing for individual-market policies.

The sponsor emphasized that the bill as amended attempts to balance patient protection and stakeholder concerns. "We stand ready for questions," Assemblymember Backus said after summarizing changes and amendments.

Ending: The committee closed the hearing after questions and testimony; no committee vote on AB 463 was recorded in this session. The bill record shows extensive stakeholder engagement and competing concerns about access, safety and cost.