As an emergency room physician, I know that time is one of a medical professional’s most vital resources. You could have a great doctor and a solid treatment plan, and catch the disease at its very first symptom, and still have medical complications because an insurance company denied the prior authorization claim.
Some lawmakers in New York are calling for increased transparency and oversight over a controversial federal drug discount program that benefits many of the state’s larger hospitals, as a nationwide debate over prescription drug pricing intensifies.
A proposal by Gov. Ned Lamont to cap the amount residents pay for out-of-network medical care is facing strong pushback from providers and hospital administrators who say the bill will result in reduced access for patients, financial burdens for providers and increased leverage for an already-powerful insurance industry.
In late March, Representatives Mark Green, MD, (R, Tenn.) and Kim Schrier, MD, (D-Wash.) reintroduced H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act of 2025. The bill calls for additional transparency in prior authorization determinations, and would also require that Medicare, Medicare Advantage and Medicare Part D plans make decisions based on medical necessity and written clinical criteria.