After a three-year effort, the Texas Medical Association recently secured a form change that allows physicians to bypass the most onerous part of prior authorization requests when renewing an existing prescription.
The Texas Department of Insurance (TDI) recently adopted an updated version of the Texas Standard Prior Authorization Request Form for Prescription Drug Benefits, which includes options for new medication therapy and continuing medication therapy. When physicians select the latter option, they can proceed without filling out certain sections of the two-page form.
Lisa Ehrlich, MD, an internist in Houston and a member of the TMA Board of Trustees, served on the TDI advisory committee responsible for the update, which she proposed.
“For those of us doctors who [prescribe] chronic medications for patients, probably 80% of our prior authorizations are actually re-authorizations of things we’ve already prescribed,” she said.
The standardized form stems from a 2015 TMA-backed state law, which requires commercial, Medicaid, Children’s Health Insurance Program, and state employee health plans to accept it and which also established an advisory committee tasked with updating the form every two years.
TMA supported the proposed form change in a March 28, 2022, comment letter to TDI.
“As TDI may know, TMA strongly supported the legislation underlying this rule proposal, as the use of prior authorization processes: (1) directly impacts patient access to coverage for care; and (2) imposes significant administrative burden on physician practices,” then TMA President E. Linda Villarreal, MD, wrote. “Having TDI prescribe a standard prior authorization form for prescription drug benefits is critical to making prior authorization processes more uniform, lessening the burden associated with their completion, and improving patient safety and access to care.”
Dr. Ehrlich says the update – now in effect – will save physicians and their practice staff time when filling out prior authorization forms on the front end. But she adds it remains to be seen whether health plans will approve continuing prescription prior authorization requests on the back end.
“In practicality, we’re going to have to see how this plays out,” she said.
TMA is monitoring the form change implementation. In the meantime, Carra Benson, who directs TMA’s reimbursement services, recommends physicians who encounter obstacles when requesting prior authorizations for continuing medications:
- File a complaint with TDI using the state agency’s online portal; and
- Submit a reimbursement review form to TMA’s Reimbursement Review and Recovery Service, which tracks member physicians’ payer issues, via fax to (512) 370-1632 or via secure file-drop.
Emma Freer
Associate Editor
(512) 370-1383