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Physicians and Patients Urge Prior‑Authorization Fixes in HB 220
Summary
Doctors, specialists and patient advocates told the House Insurance Committee that prior‑authorization delays and retroactive denials harm access to needed treatments; HB 220 would prohibit retroactive denials in many cases, tighten peer‑to‑peer review, allow 12‑month maintenance prior auths with dose adjustments, and prohibit provider appeal fees.
Supporters of House Bill 220 presented proponent testimony saying the bill would reduce administrative burden and protect patient access by tightening rules around prior authorization.
Monica Hickel, vice president of advocacy for the Ohio State Medical Association, summarized four targeted changes: (1) prohibit retroactive denials of previously approved prior authorizations except for uncovered benefits or when the patient lacked coverage; (2) strengthen safeguards in the peer‑to‑peer review process so the clinician on the insurer side identifies specialty and qualifications (the committee accepted an amendment removing a requirement to disclose a reviewer’s name for confidentiality reasons); (3) allow a 12‑month prior authorization for maintenance drugs for chronic conditions while permitting appropriate dose adjustments during that period; and (4) prevent insurers from charging providers fees to appeal denied prior authorizations.
Physicians gave clinical examples of patient harm caused by delays. Dr. Brad Fuller, a pediatrician, cited AMA survey data on physician time spent on prior authorization and said retroactive denials sometimes leave patients without needed medications, recounting a case where a child’s asthma worsened while awaiting approval. Dr. Ross Maltz, a pediatric gastroenterologist, described how delays and repeated prior‑auth requests for dose adjustments can increase hospitalizations and corticosteroid use among patients with inflammatory bowel disease.
Patient testimony reinforced the urgency: Bella Samet, a 17‑year‑old with chronic migraines, told the committee that frequent dose adjustments are common and that delays have caused prolonged pain and financial stress for her family.
Committee members probed scope and safeguards. Ranking Member Hall and others asked whether the bill might be too broad, noting legitimate reasons for denials (coding, coverage changes) and quality‑and‑safety purposes for prior authorization. Sponsors and witnesses pointed to statutory guardrails and exemptions in HB 220 intended to limit the bill to the targeted situations described in testimony.
The hearing concluded with proponents offering follow‑up information and no committee vote recorded at the session.
