Every Texan deserves the best health care possible—that means ensuring their care is safe, effective, and clinically appropriate. Prior authorization (PA) is the most important tool health insurance providers have to get patients that care. It reduces inappropriate care by catching unsafe or low-value care and targeting care that is not consistent with the latest medical recommendations—both of which contribute to potential harm and unnecessary costs for patients.

The COVID-19 crisis poses unprecedented challenges to Texas and our nation, touching every facet of American life. In the face of these challenges, Texas health insurance providers, Medicaid managed care plans, and Medicare Advantage plans are taking decisive actions to help patients and curb the spread of the virus,

Access to care is an essential part of any health care delivery system, and the Texas Medicaid program is no exception. Like private health insurance, Texas Medicaid managed care organizations (MCOs) establish a network of providers to connect Texans to the personalized care and support they need to stay healthy and live the fullest lives possible. As a result, Medicaid managed care allows Texans on Medicaid to access and choose from a variety of doctors and hospitals in their area.

AUSTIN – The Texas Association of Health Plans supports House Bill 2029, which was heard yesterday in the House Public Health Committee. The bill, by Chair Stephanie Klick, will remove unnecessary and outdated mandates that are preventing Advanced Practice Registered Nurses (APRNs) from providing more health care access and options to Texas Patients.

throughout the COVID-19 crisis, Texas health plans and Medicaid health plans have expanded access to care by encouraging and expanding telehealth services and waiving cost sharing, helping Texans receive the care they need from the safety of their homes. The crisis brought with it an explosion in the use of telehealth across Texas—regardless of patient age and type of health insurance. So far, telehealth appears to be fulfilling its promise as a significant part of the health care system.

The Texas Association of Health Plans opposes House Bill 907, which creates a new, unfunded health insurance mandate that prohibits preauthorization requirements for all drugs prescribed to treat a chronic or autoimmune disease. This would eliminate most prior authorizations for prescription drugs. HB 907 is scheduled to be heard in the House Insurance Committee on Tuesday, March 16.

Throughout the COVID-19 Crisis, health plans have done their part to help Americans get and stay healthy. Now, they are helping to increase vaccinations, especially for the most vulnerable populations who may have the toughest time getting to vaccine sites.

insulin has been around for decades, but no generic alternatives exist. That is because the pharmaceutical companies that control the market make small tweaks to extend the patents—gaming the system, artificially inflating prices, and keeping generics off the market. Even though the original patent for insulin was bought for only $1 a hundred years ago and the average cost to produce insulin is only about $6 a vial, the average price of insulin has grown by more than $300 a vial in the last 20 years.

There are opportunities for Texas lawmakers to help lower the cost of health insurance for Texas families and employers, but broadly eliminating prior authorizations is not one of them. Unfunded government mandates that eliminate prior authorizations undermine important patient protections and drive up the cost of health coverage for Texas employers.