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.
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.
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.