Oklahoma Passes Bill to Reform Prior Authorization, Boost Transparency and Efficiency in Healthcare

An Oklahoma House bill aimed at reforming prior-authorization procedures will become law next year.

House Bill 3190, named the Ensuring Transparency in Prior Authorization Act, was signed into law last week.

State Rep. Carl Newton, R-Cherokee, and Sen. Jessica Garvin, R-Duncan, collaborated with the Oklahoma Academy of Family Physicians (OAFP) to draft the legislation, which aims to enhance consistency, speed, and transparency in the prior-authorization process while reducing administrative burdens on physicians. The bill, which passed both chambers unanimously, mandates that prior-authorization procedures be published on accessible websites for patients and providers.

Senator Garvin commended Newton for his dedication to ensuring that patients and physicians retain control over medical decisions rather than insurance companies.

The bill stipulates that patients with chronic conditions must be informed at least 60 days in advance of any changes affecting their care. If a prior authorization is denied, the appeals must be reviewed by providers with the same or similar specialties. Also, health insurers must respond to urgent requests within 72 hours and non-urgent requests within seven days.

OAFP Executive Vice President Kari Webber stated that family physicians are well-positioned to advocate for policies that address time-consuming administrative tasks, allowing them to focus more on patient care. She mentioned that both physicians and an insurance group collaborated with lawmakers to ensure that House Bill 3190 benefits all parties involved.

“This issue gained significant attention last year, sparking a productive dialogue between us and the health insurance companies,” Webber said.

Webber highlighted that prior authorizations can be a cumbersome process that endangers patients.

Reforms to the prior-authorization process are occurring nationwide. In 2023, nine states and the District of Columbia enacted laws to reform these procedures.

Transparency was a key topic during the legislative floor votes. Webber emphasized that insurance companies will now be required to publish prior-authorization procedures online for easy access by enrollees and providers.

Webber noted that insurance companies aim to make the prior-authorization process more beneficial for physicians to minimize care denials. She mentioned that insurance companies were interested in using electronic systems for proper filing, reducing reliance on paper and fax machines.

“At the end of the day, 94% of physicians report care delays due to prior authorizations, and 80% report that patients may abandon treatment if a prior authorization is denied,” Webber said. “Streamlining this process to make it more efficient will improve patient health in the state, ultimately reducing overall insurance costs.”

The law will take effect on January 1, 2025, aligning with the start of the new insurance coverage period