In New Jersey, landmark bill updates requirements, increases transparency in prior authorization process

ACP-NJ Chapter advocacy was instrumental in ensuring passage of the bill; ACP members can utilize resources to effect prior authorization changes in their states

Feb. 23, 2024 (ACP) -- Advocacy by members of the American College of Physicians played a major role in pushing forward a landmark bill in New Jersey to update requirements and standards for the use of prior authorization by insurers.

"ACP members in New Jersey and our Health and Public Policy Committee were instrumental in passage of this legislation," said Dr. Elizabeth Cerceo, an associate professor of medicine at Cooper Medical School of Rowan University and chair of the committee. "We worked with the leadership at ACP's national office to develop effective communication resources to elevate this issue to the top of the priority list in Trenton."

Thanks to the legislation, which was signed by Gov. Phil Murphy in January 2024, the nation's 11th-most populous state will put several prior authorization regulations in place on Jan. 1, 2025.

As of that date, urgent requests must be processed in 72 hours and standard requests within seven calendar days. If prior authorization is denied, it must be addressed by a physician of the same specialty as the treating physician. And if patients had approval from a prior insurer, the new insurer must cover the treatment for 60 days.

In addition, there will be mandatory public reporting of prior authorization denials.

"We reduced every timeline that was in current law," Cerceo said, and increased transparency. "This is important since prior authorization decisions have always been a closed-door, opaque process in the past. This sets the stage for further refinements to the process in the state but also lays the groundwork for other states to introduce similar legislation."

The New Jersey legislature had considered fixes to prior authorization for more than 20 years, and the successful bill was introduced several times before finally reaching passage. Not surprisingly, fierce opposition came from insurers.

"The ACP-NJ chapter has been working in concert with other health care advocacy organizations in the state to push for reforms in prior authorization," Cerceo said. "This collaboration has been instrumental to move the bill forward. It was important to have solid unified support with one voice."

In regard to specific action, "our state chapter has a vibrant Health and Public Policy Committee, which discusses legislative actions at our state capital regularly," she said. "We have worked closely with ACP National to craft effective messaging to our members with embedded links to directly contact their legislators, lowering that energy needed to advocate for policies while they are still seeing patients."

In addition, Cerceo said, "we raised the issue through our regular communications with members, but also within our ACP-NJ Council to build consensus on strategy and steps forward. ACP-NJ sent updates through our e-newsletter and email blasts to members when there were relevant updates, links or Calls to Action."

In the big picture, Cerceo said, "physicians have the ability to effect change by organizing and working together. When we identify barriers to effective practice, it is important to recognize that there is something we can do about it. We can get the message out and mobilize quickly."

In addition, "we can share examples of how insurers' policies directly impact our patients," she said. "Organizing is especially important as well. When the physician specialty societies come together as one voice and share a strategic priority in advocacy that makes sense, the argument is compelling. The Access to Care Coalition has proven this strategy successful with many pieces of legislation that we've been able to stop and push through together as a unified front."

As for advice for fellow ACP members about effective advocacy, Cerceo said it "starts with listening to our ACP members to see what issues are most impacting their day-to-day practice and patients. Without that, it is difficult to get buy-in and to inspire members to participate in advocacy/Calls to Action that we send out."

And remember, she said, that "bringing the physician voice to our state capitals is critical, as we are sometimes the only ones to stand up for our patients."

More Information

An ACP toolkit on addressing the administrative burden of prior authorization is available on the ACP website.

ACP is also asking internal medicine physicians to contact Congress to ask them to support legislation related to prior authorization. Learn more at ACP's Legislative Action Center.

Back to the February 23, 2024 issue of ACP Advocate