The coalition developed 21 principles for health plans to use to reform prior authorization requirements. They focus on five broad categories:
- Clinical validity
- Continuity of care
- Transparency and fairness
- Timely access and administrative efficiency
- Alternatives and exemptions
They also deal with utilization management and pharmacy issues that address problems allergists experience with prior authorizations. Specifically, the principles address the effectiveness of treatment before cost; overriding step-therapy requirements and appeal of prior denials; a 60-day grace period for patients’ who are stable on current medications while utilization management requirements in new plans are addressed; and the extension of prior authorization approval across the duration of treatment.
The coalition members include the American Medical Association; American Hospital Association; American Academy of Child and Adolescent Psychiatry; American Academy of Dermatology; American College of Cardiology; American College of Rheumatology; American Pharmacists Association; American Society of Clinical Oncology; Arthritis Foundation; Colorado Medical Society; Medical Society of the State of New York; Minnesota Medical Association; North Carolina Medical Society; Ohio State Medical Society; Washington State Medical Society and the Medical Group Management Association.