Important Issues

On Tuesday, the Committee on Health marked-up and passed B25-124, the Prior Authorization Reform Amendment Act.

B25-124 is MSDC's highest priority and would enact reasonable limits on prior authorization for the first time ever in the District. Today moves the bill one step closer to reality.

Currently the District is one of only nine states without any prior authorization restrictions in law. This bill would, among other things, prevent prior auths for cost alone, set time limits for prior auth considerations, prohibit prior auth for emergency care and medication assisted treatment, and require insurers to publish prior auth guidance publicly.

The marked-up bill makes some changes to the original bill:

• Exempt Medicaid plans from the prohibition on prior auth solely due to cost to permit substitutes from drug formularies.
• Prohibit prior auth for medication assisted treatment.
• Permit DHCF to review prior authorizations at a different schedule than private insurers.
• Among others.

The next step is for the Council Chair (Phil Mendelson) to add the bill to the Council's legislative agenda. If the bill is added to the consent agenda, it requires two votes. If the bill is added to the regular agenda, it will require three. The Chair noted today that, despite this bill being circulated since last year, the Department of Behavioral Health and Department of Healthcare Finance have finance concerns that may require appropriations to enact certain provisions.

For more information about the bill and how to be engaged with the process, visit msdc.org/priorauth.