Prior Authorization

The Global Healthy Living Foundation, the parent non-profit of CreakyJoints, has signed onto letters being sent to all governors and Medicaid directors urging them to pursue policies that (1) prevent health insurers from imposing prior authorization requirements and (2) require health insurers to approve step therapy exemptions for high-risk individuals during the coronavirus public health emergency.

According to the U.S. Centers for Disease Control and Prevention, people with underlying conditions — in particular those who are immunocompromised — might be at higher risk for severe illness from COVID-19. Such individuals have a reduced ability to fight off infection. As such, state-regulated plans should institute policies that do everything possible to keep these patients’ underlying health conditions under control. Maintaining good control over a chronic illness, through access to necessary medication and regular health care, could help reduce patients’ need for emergency health care that could increase their exposure to COVID-19.

Services for such high-risk individuals should be fully covered for the duration of this public health emergency. Further, these services should be covered without step therapy or prior authorization requirements if a patient’s health care provider deems treatment medically necessary.

Step therapy is the idea that individuals should “fail first” on treatments — often less expensive ones — specified by a health plan before they can start a treatment prescribed by their health care provider.

Prior authorization means that an individual must obtain approval from a health plan before the plan will cover the cost of a service.

During an emergency such as the coronavirus pandemic, it is imperative that patients get the right treatment without delay. Requiring patients to go through step therapy and prior authorization protocols could needlessly delay important medical care at a crucial time.

The risk for developing serious complications from COVID-19 could be significantly reduced if the underlying high-risk condition is well managed.

We need patient voices demanding for better access to treatment for high-risk Americans during this public health emergency.

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About the 50-State Network

The 50-State Network is the grassroots advocacy arm of CreakyJoints and the Global Healthy Living Foundation.

It is comprised of patients with chronic illness who are trained as health care activists to proactively connect with local, state, and federal health policy stakeholders to share their perspective and influence change. Through public and personalized opportunities to advocate for the chronic disease community, the 50-State Network mobilizes patients to voice their concerns about access to treatment, quality of care, and the need to prioritize the physician-patient relationship. Learn more at 50StateNetwork.org.