The Immune Deficiency Foundation (IDF) supports policies to ensure that health insurance prior authorization criteria, standards and processes for primary immunodeficiency (PI) treatments, including all modes of immunoglobulin (Ig) replacement therapy, hematopoietic stem cell transplantation (bone marrow transplant) and gene therapy, are appropriate, fair, streamlined, and transparent.
What Is Prior Authorization?
Before an individual can receive a particular prescription therapy, doctors must submit information to the insurance company detailing the patient’s specific need for the medication. Once the insurance company has received the doctor’s justification, they will approve the medication, and the patient can receive his or her treatment. Insurance companies apply prior authorization procedures to certain high cost medications to contain healthcare spending. They do this to ensure that a prescription is medically necessary before agreeing to pay for it.
IDF engages in state advocacy in support of legislation to limit prior authorization requirements that delay patient access to necessary treatments. The legislation is aimed at implementing a streamlined and standardized process to submit prior authorization information and aimed at shortening the time between when a patient is prescribed a therapy and when they begin treatment.