Prior Authorization Testimony – Dr Du

Chairperson and members of the Committee on Health, my name is Dr. Nicole Du and I am a pediatrician in training, practicing in the District of Columbia. I am also a member of the DC Chapter of the American Academy of Pediatrics. I’d like to thank the Committee for holding a public hearing on B25-0124 – the Prior Authorization Reform Amendment Act of 2023 and would like to tell you why I am in favor of this Bill.

Prior authorizations burden health care providers, delay patient care, and cause patient harm. I am here today to share how prior authorizations cause unnecessary delays for pediatric care and how prior authorizations harm DC children.

A 7 year old patient of mine had to stay an entire extra night in the hospital recently because her liquid antibiotic required a prior authorization—even though this particular antibiotic has been well documented as the first-line treatment for her infection. In a hospital full of cutting-edge medical technology, we found that our only way to get the patient back home to her family was to get a packet of Skittles from the vending machine and use them to teach her to swallow pills. We had to do this because the only type of the medicine that was available to her without a prior authorization delay was in pill form.

I was recently on the phone for hours with a distraught mother of a 6-month-old baby who was trying to make sense of the $2,000 cost of a medication for her baby’s urinary tract infection. We were appealing to her insurance company for a required prior authorization for her medication, so the mom had to choose between paying out of pocket or seeing her baby in pain for days more until we could get her the appropriate treatment.

Another child was brought seizing into our emergency room because his parent was not able to pick up his home seizure rescue medication prescribed by his doctor. The medication had required a prior authorization and the decision by the insurance company was still pending when the child began seizing at home.

These are just a few of the many young children who have suffered, first-hand, the negative consequences of an unregulated and burdensome prior authorization process. As their pediatricians, we spend hours each day arguing for their medications to be covered. The AMA found that physicians across the country, not just in the District, complete 41 prior authorizations per week—putting children at risk for delayed care far too often. The stories I shared today all came from children who were insured by DC Medicaid and its associated managed care organizations. Children whose families cannot afford to pay out of pocket for their first line, evidence-based treatments.

I urge DC Councilmembers to support and pass the Prior Authorization Reform Amendment Act of 2023 to prevent DC children from facing delays in medical care.

Thank you so much for your time. Please let me know what questions you may have.