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MDACC members: advocacy in action

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Bills in both the Maryland House of Delegates and Senate have been introduced to reform prior authorization and step-therapy.  MDACC is supporting these reforms through letters, in-person testimony, and an email campaign to the membership.  See below for more details.

RE: SUPPORT FOR SB 308 Health Insurance – Utilization Review – Revisions and

SB 515 Health Insurance – Step Therapy or Fail First Protocol – Revisions

These bills target the unnecessary denial of health care services by health insurers. Commonly known as prior authorization or step therapy, these practices often delay or deny medications and services that have received clinical consensus through stringent vetting and are published and updated regularly in medical journals and literature.

Time is critical for cardiovascular patients. The sooner a cardiologist can treat and monitor a

patient, the more likely the patient is to recover and thrive. Unfortunately, insurer prior authorization program denials in Maryland are rising.

Increasingly, cardiovascular professionals use point of care tools (ACC Practice Tools) and other technological resources (NCDR National Cardiovascular Data Registry) to access information that provides update information that guides treatment decisions and helps them provide timely care.

  • In 2018, there were 78,314 denials based on medical necessity.
  • In 2021 that number increased to 81,143.
  • The Maryland Insurance Administration (MIA) ruled that in over 70% of complaints they received from patients, the denial was invalid, and that the patient should have received the health care service.

In 2021, an American Medical Association (AMA) survey revealed the following about the impact of prior authorization on physicians and patients:

  • 93% of physicians reported delays in access to necessary care.
  • 82% of physicians reported that patients abandoned recommended treatments because of prior-authorization denials.
  • 73% of physicians reported that criteria used by carriers for determining medical necessity is questionable - 30% of physicians reported that it is rarely or never evidence-based and 43% only sometimes evidence-based.
  • 88% of physicians describe the burden of prior authorizations as high or very high with 40% of physicians reporting that they have staff dedicated exclusively to prior authorizations.

Not only are these policies hurting patients, but they are hurting physicians, too.

The process to secure prior authorization is labor intensive, costly, and stressful. Surveys consistently reveal that undue administrative burden is a leading cause of physician burnout and depression.


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Maryland Chapter, American College of Cardiology
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