Prior Authorization

Insurers, both public and private, use prior authorization to rein in costs and keep a watchful eye on prescribing practices of physicians and other healthcare providers. In recent years, state legislators have restricted the ability of insurers to utilize prior authorization. Some states have taken the approach that diagnoses of specific disease states don’t require prior authorization for treatment, others have adopted the “gold card” process: exempting specific providers who have a track record of approvals for prior authorization requests.

MultiState tracks all legislation and regulations related to prior authorization, step therapy, and fail first. Additionally, we produce high-level evaluations of trends surrounding these issues as well as deep dives into specific proposals.