Essentia Health applauds North Dakota legislature, governor for reforming prior authorization process

On Wednesday, April 23, Essentia Health leadership joined North Dakota Governor Kelly Armstrong and advocates at a bill signing ceremony to highlight prior authorization reform. The legislation (Senate Bill 2280) passed the North Dakota legislature with near unanimous bipartisan support. To advance the legislation, Essentia led a coalition of 20 health care and patient advocacy organizations representing physicians, pharmacists, hospitals, physical therapists, and advocates for seniors, children, cancer patients and individuals.

 

The landmark legislation will ensure prior authorization is used consistently, efficiently and in a manner that guarantees more timely access to health care for North Dakotans.

 

Prior authorization is a process used by insurance plans to manage the use of health care services. While designed to ensure appropriate and cost-effective use of medical treatments, prior authorization often leads to delays in patient treatment and administrative burdens for health care providers. It can also prevent patients from receiving necessary care due to lengthy and often-arbitrary approval processes and, increasingly, denials. What was once used sparingly for specialized care has now become common for basic services.

 

"As a leader in rural health care, Essentia understands the challenges confronting the communities we serve, including access to the right level of care at the right time and as close to home as possible," said Dr. Stefanie Gefroh, Essentia's West Market president. "Prior authorization requirements can slow patient care for days and even weeks, which can lead to more aggressive, expensive treatments, longer hospital stays and emergency interventions. This drives up health care costs and — more importantly — negatively impacts patient outcomes.

 

"That is why we worked tirelessly to advance this legislation. We are grateful to advocates from across North Dakota who pushed for these patient-centered reforms and the lawmakers who supported this critical legislation."

 

According to a 2023 American Medical Association survey of physicians across the country, physicians and their staff spend an average of 14 hours each week — almost two business days — to complete prior authorization requests. Eighty percent of physicians reported that the number of requests required for prescription medications and medical services has increased over the last five years, with 92 percent reporting prior authorization causing a delay in care.

 

Prior to the passage of SB 2280, North Dakota was one of a few states where there was no oversight of the prior authorization process under state law.

 

In addition to standardized definitions and disclosure requirements, two key aspects of SB 2280 that will have a direct and positive impact on patient care include:

 

Senators Scott Meyer (Grand Forks), Jeff Barta (Grand Forks), Brad Bekkedahl (Williston) and Sean Cleary (Bismarck), and Representatives Jonathan Warrey (Casselton) and Jon Nelson (Rugby) led the legislative effort to pass this commonsense bill into law.