Tag Archives: prior authorization

Given that ‘step therapy’ is also called ‘fail first,’ there are many angles to pursue

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: ZaldyImg via Flickr

For journalists covering the Trump administration’s plan to expand step therapy to Medicare Advantage, there are important angles to cover now.

Under the rule issued by the federal Centers for Medicare and Medicaid Service, Medicare Advantage plans will now be able to use so-called step therapy when physicians prescribe drugs under Medicare Part B. Continue reading

Prior authorization rules: Yet another way the health insurance system frustrates physicians and patients

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

For patients and physicians, many aspects of the health care and health insurance systems are frustrating and appear to be needlessly complex.

One of the most frustrating processes is prior authorization, the mother-may-I approach health insurers use to ensure that procedures, medications and even certain care processes are appropriate and worthy of coverage. Continue reading