States have generally tried to attack the problem in four ways, said Kaye Pestaina, the director of the program on patient and consumer protection at KFF, a nonprofit research organization.

The first strategy is to shorten the amount of time an insurer is allowed to decide on a medication or service request.

The second is to reduce the administrative burden physicians experience, often by giving a pass to doctors who have a high rate of approvals — Texas' gold card system is one example.

The third approach is to bolster transparency and data requirements.

And the fourth focuses on the review process itself by mandating that decisions be based on peer-reviewed, clinical data.

Pestaina said it might take years to determine which strategy, or combination of strategies, would yield the best outcomes.

In Texas, for example, the 2022 gold card law so far has had mixed results. Doctors who have received the pass say there's a more streamlined process, but there aren't very many of them: Only 3% of physicians had achieved gold card status by the end of last year, according to the Texas Medical Association.

"That should really be upside down and in the other direction," said Resneck, the former American Medical Association president. "We should see 97% of doctors getting gold cards instead of 97% not getting them."

Enforcement challenges

State insurance commissioners largely will be responsible for enforcing the state laws. Many of the new laws empower commissioners to investigate insurers, issue fines for noncompliance and even take insurers to court to remove their license to operate in the state.

...continued

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.