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In 2021, Texas passed first-of-its-kind legislation to exempt physicians from prior authorization requirements if they had a certain percentage of approvals for an individual service. Also known as a “gold card,” this law was an exciting development for physicians nationwide, as policymakers were finally taking action to reduce the burden of prior authorizations.
With the law going into effect late last year, CSRO surveyed Texas rheumatologists to evaluate the effectiveness of this approach and found that many physicians struggled to qualify – 88% of respondents reported they did not receive a gold card. This could be due, in part, to insurance company errors, but could also be due to unique difficulties in qualifying for an exemption when it comes to prescription drugs. Between treatment variety, interval, and patient volume within a specific insurance plan, rheumatologists may struggle to meet the threshold of requests required to be considered for a gold card, and for those that do qualify, it is unclear whether they are exempt from other utilization management restrictions such as step therapy.
Responses did show that the new law was helping their procedures – it was reported that when a gold card exemption was received for MRIs, administrative burdens faced by offices did decrease. While there are indications that more work needs to be done, CSRO is encouraged that state legislators across the country are considering policy to help reduce the administrative burden issues created by prior authorization.
This new law in Texas is a significant building block that CSRO hopes will pave the way for additional developments throughout the states and help ensure more patients have access to the care that they need.
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