ArthritiChrissy

When I was diagnosed with rheumatoid arthritis, my doctor immediately started me on the gold standard of RA treatment – methotrexate. While it helped, it unfortunately wasn’t effective enough on its own to control my pain and inflammation. So, my doctor, in an attempt to control the inflammation to prevent permanent joint damage, prescribed a biologic.

“Not so fast!” the insurance company cried. My heart rate skyrocketed as I opened the letter that spelled out those words that so many of us have read, “Your pre-authorization request for the services above has been denied.”

Oh.

Unbeknownst to me, my doctor had already filed an appeal, explaining how I had not adequately responded to methotrexate-only therapy, and my medication was then approved. While this was good news, I can’t help but think about how much time was spent sending the first request, then appealing the denial, all just to get the medication my doctor prescribed.

Wouldn’t this have been faster, cheaper, and easier for all involved if I was just able to access that medication once it was prescribed?

It turns out about 1/4 of prior authorization requests are denied, and 80% of those denials are later approved.

That feels like a lot of wasted time and energy.

In fact, an average practice spends 12 hours a week filing and appealing prior authorization requests.

Prior authorizations are used by insurance companies to ensure tests and medications are necessary. It’s a cost management strategy that conceptually makes sense, but in practice is harming patients.

29% of doctors say that prior authorization delays or denials cause serious adverse events such as permanent joint damage or hospitalization.

There’s Legislation to Fix This

Several bills targeting prior authorization have been introduced in Congress. These bills call for quick turnarounds for prior authorizations, if prior authorizations are used at all.

What Can You Do?

First, identify your senators and representative.

To find your representative, visit: house.gov/representatives/find

To find your senators, visit: senate.gov/senators/senators-contact.htm

Or, use the Arthritis Foundation’s tool at arthritis.org/advocate. This will look up your lawmakers automatically, AND provide pre-written templates you can customize!

Next, decide if you’re making a phone call, sending an email, or both! Phone calls can be more persuasive, but all contacts are counted! Don’t be discouraged – communicate in the way that works best for you.

Here are some sample scripts to get you started! Make sure to add your personal touch – advocacy is all about telling YOUR story. Each story is powerful and key to changing laws. If calling, you’ll likely speak to a staffer. Whether on the phone or email, keep it brief to respect the receiver’s time and attention!

Email Template

SUBJECT: Support Prior Authorization Reform

Dear Representative/Senator [Name],

My name is [Name] and I’m your constituent from [City]. I have rheumatoid arthritis and regularly face prior authorization delays for necessary medications.

I’m asking you to support legislation that reforms prior authorization requirements. These delays harm patients and can lead to serious adverse health events.

Please co-sponsor and support prior authorization reform bills.

Thank you, [Your name] [Your city/ZIP]

Phone Script

My name is [Name] and I’m your constituent from [City]. I have rheumatoid arthritis and regularly face prior authorization delays for necessary medications.

I’m asking you to support legislation that reforms prior authorization requirements.

Prior authorization delays harm patients. Legislation has been introduced that would create reasonable timelines and reduce unnecessary barriers to care.

Please co-sponsor this bill and support prior authorization reform.

Thank you, [Your name]

Your Challenge

You are now ready to advocate for prior authorization reform!!

I’m now challenging you to take action TODAY. Take five minutes to look up one representative, fill in the blanks of a sample email or phone script, and reach out to tell your story. When you’ve done that, drop me a comment so we can celebrate! You might be surprised how empowering it can feel to advocate for yourself and others.

Join me in being an advocate for arthritis!