HARRISBURG (TNS) — Pennsylvania lawmakers this week approved a bill they say will end many problems related to “prior authorization” — where an insurance company can prevent a doctor or hospital from providing a treatment or drug until the insurer says it’s covered.

The bill also changes the related practice known as “step therapy,” where an insurer requires a doctor to prescribe certain treatments or drugs, typically less expensive, unless they prove ineffective.

Both practices were intended to hold down the costs of medical care, especially the use of expensive new or experimental treatments.

But patients as well as doctors and hospitals have long pointed to problems with the processes, saying they can delay getting needed treatment, prevent doctors from prescribing what they believe is best, and add to the administrative burden.

The bill will “require insurers to provide timely approval for both non-urgent and emergency health care services to physicians before services and treatment plans are rendered. The bill also creates streamlined guidelines for step therapy for prescription drugs, as well as new options for patients and their medical professionals to obtain exemption to best treat the medical condition of the patient,” according to a news release from state Sen. Kristin Phillips-Hill, a York County Republican who wrote the Senate version of the bill.

The bill applies to private health insurance and Medicare coverage.

Gov. Tom Wolf is expected to sign the bill.

The bill “establishes clear and predictable processes that will reduce delays in medically necessary care for patients, while also lessening costly administrative burdens for hospitals and health care providers,” according to the Hospital and Healthsystem Association of Pennsylvania.

The bill requires to insurers immediately say whether or not something is covered and give written notice of denials. People can appeal decisions to the state insurance department. If a doctor disagrees with an insurer over a step therapy decision, the doctor is guaranteed quick access to an insurance company doctor to discuss the situation.

RELATED:

Need spinal fusion or hip or knee replacement? New report helps find best place to go in Pa.

Medical marijuana patients get good news, but producers fret over Pa.’s final law

©2022 Advance Local Media LLC. Visit pennlive.com. Distributed by Tribune Content Agency, LLC.