New Jersey legislation aims to speed up prior authorization process

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New Jersey resident Sandra Johnson started feeling short of breath a few years ago, and sometimes it really limited what she could do.

“Getting up to walk from my bedroom to the bathroom, I will be so out of breath that I would have to just sit on the toilet with the seat down … to prepare myself to get up to take a shower,” she said.

Her physician diagnosed her with severe persistent asthma and prescribed an injectable drug. Before she could get started on the treatment, Johnson’s doctor had to go back and forth with her insurance provider to convince them that she really needed this drug, a process called prior authorization. The insurance company approved it, and once Johnson got the treatment, she said she felt better. She could go back to her job as a clinical coordinator, do chores and go grocery shopping without trouble.

But a few months ago, her insurance provider needed prior authorization again, for the same treatment. This time, the answer was no. Johnson has been without the medicine for months.

“I don’t have an understanding of why it’s being denied when this medication that I have been taking has been working for me, allowing me to have a better quality of life and being able to function on an everyday basis.”

This is a common and disruptive problem, said Tina Shah, a pulmonary and critical care doctor in New Jersey and also the chief clinical officer of Abridge, a medical AI company.

“This causes so much moral distress that I often go home, and I have to decompress because I know that I can be the best doctor, but because of prior authorizations I often can’t deliver the best care,” she said.