STATE HOUSE – The Senate accepted laws this week sponsored by Senate Well being and Human Companies Committee Chairwoman Melissa Murray to ban insurers from requiring prior authorization for medically needed well being care companies and prescriptions ordered by sufferers’ major care suppliers.
The invoice – 2025-S 0168A – is a part of a nine-bill package of legislation Senate management has endorsed this session to deal with well being care accessibility and affordability.
“It’s the well being care suppliers, not insurers, who know greatest what care is required for his or her sufferers. And we want our major care suppliers targeted on offering care, not haggling with insurance coverage corporations,” stated Murray, a Democrat representing District 24 in Woonsocket and North Smithfield.
The laws would prohibit insurers from imposing prior authorization necessities for any admission, merchandise, service, remedy, check, examination examine, process or prescription drug ordered by an in-network major care supplier, together with basic internists, household physicians, pediatricians, geriatricians, OB-GYNs, nurse practitioners, doctor assistants and different well being care suppliers who’re licensed to supply, coordinate, and supervise major care and order well being care companies and items, together with preventive and diagnostic companies for sufferers.
It might not apply to prescriptions for managed substances, and offers an exception for insurers to impose prior authorization necessities for particular person major care suppliers who’ve a documented historical past of fraud, waste or abuse.
If enacted, the invoice would take impact Jan. 1, 2026. The laws now goes to the Home, the place the same invoice – 2025-H 5120 – is sponsored by Rep. Brandon Potter of Cranston.
According to the American Medical Association, which has been advocating to scale back prior authorization necessities, the common doctor apply completes 45 prior authorizations per doctor per week. According to the most recent AMA survey, 94 p.c of physicians imagine prior authorization delays care. The Rhode Island Medical Society has additionally advocated for reductions in prior authorization necessities.
