Physicians are implementing information technology systems that allow us to easily view each patient’s treatment history in order to make informed health-care decisions and diagnoses. Through health IT systems, doctors can also electronically prescribe medications — sending them directly to the pharmacist’s inbox. This has the potential to save money and help patients quickly access the care they need.
But significant roadblocks must be lifted by the General Assembly before these new systems can reach their full potential.
As a physician, I have no way of knowing whether my patient’s insurance company will cover the treatment that I electronically prescribe. It’s not uncommon for an insurance company to refuse to cover medications because of cost or demand pre-approval, known as a “prior authorization,” before covering a prescription.
Physicians should be able to obtain these prior-authorization requests through our health IT systems. Instead, when a patient is denied at the pharmacy, my office must engage the insurance company in a long back-and-forth of faxes and phone calls.
The problem is that insurance companies prefer to stick to a time-consuming and antiquated paper trail that keeps sick patients waiting for their medication for days or even weeks. My patients’ conditions can worsen while the treatments they need are caught in insurance limbo.
An American Medical Association membership survey found that 69 percent of physicians typically wait several days to receive prior authorization, while one in 10 waits more than a week. Meanwhile, both physicians and pharmacists can spend up to 20 hours per week just dealing with prior-authorization requests. The survey estimated that prior authorizations annually cost physicians $23 billion to $31 billion nationwide.
Health-care providers are frustrated, and so are our patients. We have invested in health IT because of the enormous potential it holds for our practices and our patients. But we need the cooperation of insurance companies in order to make the most of these new systems.
It’s time for legislators to put an end to this exhaustive paper trail. When the General Assembly takes up insurance issues this year, it should make sure that all prior authorizations can be done electronically. With help from legislators, we can create a seamless treatment system — and a healthier South Carolina.
Hugh Durrence, M.D.