To health insurers, a new Texas law that significantly limits prior authorization practices will effectively eliminate health care providers’ accountability to offer safe, high-quality and cost-effective care. To Texas providers, the measure is a long-awaited first step toward having clinicians spend less time on arduous paperwork and more time on patient care.
Industry observers say both sides have valid arguments, but they also worry that Texas’ legislation may be so difficult to implement that even its best intentions could fall flat.
House Bill 3459 — which Republican Gov. Greg Abbott signed into law in June — allows physicians who have had PA requests for prescriptions and treatments approved by a private insurer 90% of the time in the most recent six-month review period to receive a “gold card” PA exemption from the insurer for the applicable prescription/treatment. That requirement will go into effect on Jan. 1, 2022, but starting Sept. 1, 2021, health plans must use Texas-licensed physicians of the same or similar specialty as a treating physician when conducting peer-to-peer review calls with doctors seeking prior authorization.