Many health plans impose burdensome preauthorization requirements to discourage physicians from prescribing drugs that are not in the plans’ formularies. At last year’s annual meeting, CMA’s House of Delegates passed a resolution that instructed the association to “prioritize its managed care advocacy efforts to provide relief to physicians from burdensome health plan preauthorization requirements for medically necessary prescription drugs.”

To defend you and your patients, CMA needs examples of problem areas and urges physicians and/or their staff to provide CMA with specific examples of drug preauthorization difficulties that you have experienced, including a plan that:

• requires preauthorization for prescription renewals for patients with chronic or urgent conditions
• only accepts preauthorization or exception requests directly from the physician by telephone, rather than by fax or e-mail
• fails to respond to preauthorization or exception requests within 72 hours
• requires preauthorization for all drugs in a class
• requires burdensome preauthorization documentation
• takes drugs off its formulary and refuses to pay for previously covered drugs that were prescribed for its enrollees before the formulary was changed.
• requires a patient to go through step therapy, even when not in the patient’s best medical interests, before authorizing a nonformulary drug that the physician believes to be medically necessary.

Help us fight health plan interference in the doctor-patient relationship. For each problem, please download the complaint form and fax it with any relevant supporting documentation to CMA at 415/882-5143. Your responses will be carefully reviewed by CMA’s Committee on Medical Services.

Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org.