Prior Authorization Reform is Needed for Timely Patient Access to Critical Laboratory Tests
Mary Lee Watts, ACLA Vice President of Government Affairs and Policy
Clinical laboratory test services range from routine testing to ascertain basic health, to the most advanced and innovative genetic testing, foundational to personalized medicine. Timely access to laboratory testing for patients and the providers who care for them is critical because these tests inform approximately 70% of health care decisions, help guide treatment, and impact patient outcomes. For patients, some payer policies result in denials and delays in testing, which can have life threatening consequences.
Prior authorization policies enacted by many payers are increasingly moving beyond limited efforts to ensure appropriate utilization of testing and instead are being applied more broadly, often blocking or delaying access to necessary care. These policies harm patients by restricting access to a wide array of necessary tests, including liver and metabolic panels, genetic testing for mutations that increase the risk of developing cancer, prenatal screening tests, infectious disease testing, and biomarker testing used to determine the most effective cancer treatment.
