Prior authorization (PA) refers to the process of getting an insurer’s approval before a physician provides a treatment, and can dangerously delay access to medication and care. Real-time benefit tools (RTBTs), a software product physicians consult before finalizing a prescription, can decrease the burden of PAs or help physicians avoid them altogether. This project proposes that the the New York State Department of Health (DOH) adopt a statewide standard to make RTBTs more usable and reliable and therefore decrease the burden of PAs.
Click below to view various resources for setting a prior authorization standard in New York, including a policy brief further explaining the proposal and a draft regulation for the State of New York’s Department of Health.
