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Stephen Marmaras: Prior Authorizations for Biologic Drugs


Stephen Marmaras, director of policy and advocacy for the Global Healthy Living Foundation, discusses the challenge of prior authorizations.


How would you like to see prior authorizations change to reduce the burdens for patients and physicians?

When we talk to physicians that treat patients with many of the chronic, complex diseases that make up our community, they tell us that it’s maddening the diversity of prior authorization forms. Unfortunately, many of them tell us it’s only the offices that devote full-time staff to prior authorization forms where you see patients getting the drugs that their physicians prescribed.

We think that that’s just an absolutely ridiculous system where patients are only receiving the drugs their doctors prescribed because there’s staff on hand to process forms. So, what we’d like to see done is have more legislation pass that requires uniformity of prior authorization forms. Florida took a massive step forward in doing that last year, but I think there’s still more reform efforts that need to be undertaken.

I think we need to apply some penalties to that type of legislation, so that if insurers are found to not be in compliance with standardization of prior authorization forms that there’s some sort of monetary penalty for doing that, per instance, not for a totality. It’s really critical that insurers are talking to physicians. I think that physicians need to be engaged really on a focus-group level in state—specifically in-state, talking with the specialists in-state or even general practitioners to some degree—to get an understanding of what are the major hurdles and barriers in the prior authorization forms that currently exist.

I think that a lot of times there are no answers to those questions and those conversations haven’t been had. They need to occur. We’d love to help them occur, we’d love to connect insurers in states with specialty physicians that we know have had difficulty, and their patients have had difficulty, with processing prior authorization forms.

But we should never live in a world where a person with a chronic disease can’t get access to a drug because their doctor or staff hasn’t or can’t fill out a form correctly or doesn’t have the time to fill out a form because it’s so onerous.

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