Safe Care and Prior Authorizations

From overtesting and overdiagnosis to overtreatment, health care waste and unsafe care contribute not only to patient harm but also to unnecessary costs. According to a 2019 study in JAMA, the estimated annual cost of waste in the U.S. health care system is upwards of $935 billion, accounting for nearly 25% of total health care spending.

 

A 2018 report to Congress found that a significant percentage of patients received low-value care, resulting in between $2.4 billion and $6.5 billion in Medicare spending in 2014 alone. Physicians have reported that at least 15-30% of medical care is unnecessary or unsafe. Doctors and clinicians provide important care and life-saving treatment and agree that we all need to work together to avoid care that is inappropriate, unnecessary, and more costly. That’s what prior authorization helps deliver. By having a 360 degree view of a patient’s medical history, health plans can help ensure that medications and treatments are safe, effective, and affordable for patients.

 

Health plans are committed to reducing unnecessary burdens. However, efforts to limit or eliminate the use of prior authorization or post-utilization review negatively affect affordability, safety, and quality for everyone. By focusing on reducing waste and enhancing safety, we can ensure that Texans receive the high-quality care they deserve.

Safe Care and Prior Authorizations Resources

All

Policy Papers

TAHP Presentations

101s

Testimonies

Comment Letters

Legislative Briefs

Testimony Opposing SB 1150: One Prior Authorization for 12 Months

Electronic Filing of Prior Authorization Benefits Patients and Providers

TAHP Opposes HB 907: Don’t Eliminate Protections of Prior Authorization

Testimony Opposing SB 1150: One Prior Authorization for 12 Months