Prior Auth Bill Receives Bipartisan Support in Senate Committee, House Bill Faces Upcoming Deadline

March 14, 2024

MMA’s top legislative priority, SF 3532 (Morrison, DFL – Deephaven) received strong bipartisan support in a hearing on March 13 before it was laid over for future inclusion in a committee omnibus bill. 

The legislation prohibits prior authorization for services where a delay in care may lead to serious negative patient health outcomes. These include mental health treatment, substance-use disorder treatment and cancer treatment. The bill would also limit prior authorization to one-time only for treatment for chronic conditions, unless the standard of care changes. The bill also prohibits prior authorization on preventive health services, generic drugs, and biosimilars. 

The legislation requires health plans to submit data reports to the Commissioner of Health and requires that health plans maintain an automated process for prior authorization. 

Proponents of the legislation, including medical societies, hospital systems, patient advocacy groups, and other provider groups, testified that prior authorization causes delays in care which leads to negative health outcomes. This is supported by national data from the AMA showing that 89% of physicians report that prior authorization has had a negative effect on patient clinical outcomes and one in three say prior authorization has led to a serious adverse event for a patient.  

Opponents from the Minnesota Council of Health Plans and the Pharmaceutical Care Management Association, and the for-profit insurers continue to argue that prior authorization is a necessary tool to protect patients from unnecessary costs and potentially dangerous or unnecessary treatment. 

Legislators on both sides of the aisle expressed frustration that prior authorization is getting in the way of good patient care. “We’ve also heard there are 81,000 prior authorizations occur annually in just one system,” said Sen. Alice Mann, MD, MPH (DFL – Edina). “When opponents say prior authorization is a useful tool, I think to myself, how am I supposed to believe that 81,000 times the doctor prescribed the wrong prescription or the wrong treatment? And that 81,000 times, just for one system, they caught that and saved money. That’s absurd. And then we hear that when these prior authorizations come back, they prescribe tablets for two-month-olds and adult medications for children. For someone who has never seen my patient, talked to my patient, or touched my patient, they think they know the treatment for my patient better than me or a physician who has been sitting with the patient for months, years, or their lifetime.” 

The legislation was laid over for inclusion in a future omnibus bill while the committee awaits the official fiscal note, which will show what the costs will be to state agencies to implement the bill. The bill will have no other committee stops until that omnibus goes to the Finance Committee, and then the Senate floor for a vote. 

The House companion bill, HF 3578 (Bahner, DFL-Maple Grove) is currently in the Commerce Committee and needs to be acted on to send it to the House Health Finance and Policy Committee. This action must be taken before the first bill deadline on March 22. All non-omnibus bills that fail to be laid over by 5 pm on March 22 are considered inactive, barring action by a Rules Committee.