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Congressman Mike Thompson

Representing the 5th District of CALIFORNIA

Rep. Thompson Co-Sponsors Legislation Designed to Improve Prescription Access for Medicare Beneficiaries

Jan 23, 2018
Press Release

Washington, DC – Today, Reps. Mike Thompson (CA-05), Bill Johnson (OH-06), Ben Ray Lujan (NM-03), and David Schweikert (AZ-06) announced they have introduced H.R. 4841, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, which is designed to improve access to prescription medications for Medicare beneficiaries.

“This legislation is another step toward modernizing Medicare and making it work better for patients,” said Rep. Thompson. “By standardizing the way electronic prior authorization systems operate under Medicare—ultimately mitigating delays for seniors needing prescriptions-- we can greatly improve efficiency and patient experience. I’m proud to sponsor this bipartisan bill and I’ll continue to work to help bring Medicare into the 21st century.”

“I joined a bipartisan group of my House colleagues in introducing legislation that will improve access to prescription medication for Medicare beneficiaries. This bill would improve the outdated and inefficient prior authorization (PA) process and allow patients to obtain needed prescription drugs without unnecessary delay,” said Rep. Johnson. “There are currently a number of medications that require a prescriber to obtain approval from an insurance plan before dispensing. The process often requires prescribers to make lengthy phone calls or use a fax machine to obtain PA, which causes unneeded delays for patients waiting for their important prescriptions. In the commercial market, a process known as electronic prior authorization is widely used, allowing prescribers to request, and insurers to grant, PA in a fraction of the time. However, for unknown reasons, Medicare has been too slow to adopt this technology. The legislation I co-sponsored encourages Medicare to use this technology, which will help reduce abandoned prescriptions left at the pharmacy, increase efficiencies in the appeals process by reducing claims, and ensure Medicare enrollees get the right treatment at the proper cost share. Many residents of Eastern and Southeastern Ohio are dependent on the Medicare program, and anything that helps them get their needed medication more efficiently is beneficial.”

“Too often the prescription authorization process for those enrolled in Medicare is lengthy, confusing and frustrating,” said Rep. Lujan. “The purpose of our bill is to streamline the process, eliminate frustrating delays and allow seniors to get the prescriptions they need with a minimum of fuss,” said Lujan.  “By standardizing the electronic prior authorization system, our legislation makes Medicare easier for seniors. That’s good for patients and ultimately good for ensuring the Medicare system operates as cost efficiently and effectively as possible.”

“With a large portion of the commercial market effectively using electronic prior authorization (ePA), and a number of states that have standards in place, this legislation is an essential step forward towards standardizing ePA in the Medicare program, the largest payer in the nation,” said Rep. Schweikert. “Standardizing ePA will improve efficiencies in Medicare and ensure safe prescribing for patients. Individuals will no longer be turned away from the pharmacy counter and can begin their doctor-prescribed therapies without delay."

A number of medications require approval by a health insurance plan prior to dispensing in order for the plan to cover the medication, a process known as prior authorization (PA). Should a PA not be obtained prior to dispensing, the patient is faced with the choice of waiting for a PA or paying for the medication out-of-pocket.

The traditional PA process uses outdated modes of communication which can be burdensome for the provider and pharmacist and often causes undue delays for the patient. Electronic Prior Authorization (ePA), which has seen widespread and successful adoption in the commercial market, automates the process by streamlining communication among providers, payors and pharmacies. This bill would encourage the use of ePA by creating system standards under Medicare, thereby promoting adoption by Medicare providers and bringing appropriate treatments to seniors faster.

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