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Faster Drug Coverage Decisions Expected Under New Proposal

Dec. 10, 2020, 10:51 PM

Patients could get their medications faster under a Medicare agency proposal that tightens insurer response times for coverage decisions.

Sometimes insurance plans demand to sign off on medications before they agree to cover them. In those situations, doctors have to explain to the insurance company why a patient needs a specific drug. The process is called “prior authorization” or “step therapy” and it happens most often with expensive brand drugs. It’s a way for insurers to cut costs by encouraging patients to use generic drugs, which are cheaper.

Prior authorization eats up a lot of resources though and contributes to...

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