The proposed bill would also ban prior authorization on drugs under $100 and prohibit the use of step therapy protocols on certain drugs, according to the report. It also requires that a physician within the same specialty issue a denial, rather than an algorithm or a physician with a different background.
The bill is sponsored by Sen. Tyler Johnson, MD, who is an emergency care physician, according to the report. He said the 1% cap was “aggressive” and necessary to disrupt the process.
“What I would prefer is to get rid of all prior [authorizations],” Dr. Johnson said, according to the report. “I have yet to hear somebody justify prior authorization and the delay and the denial of treatment for patients.”
A lobbyist for the Indiana Association of Health Plans defended prior authorizations, stating that the process ensures “patients are getting the safest, most effective care in the right place, the right time and at the lowest cost,” according to the report.
