Dear Honorable Members of the New Jersey General Assembly Committee on Financial Institutions and Insurance,
On behalf of people with cystic fibrosis living in New Jersey, we write to express our support for the Ensuring Transparency in Prior Authorization Act (A1255), which makes several important reforms to the prior authorization (PA) process. PAs can delay access to critical CF therapies, and the Cystic Fibrosis Foundation supports efforts to minimize the administrative burden PAs impose on patients and their providers. We urge you to support A1255 to ensure immediate and consistent access to therapies for people living with CF in New Jersey.
About Cystic Fibrosis
Cystic fibrosis is a life-shortening genetic disease that affects nearly 40,000 children and adults in the United States, including more than 700 people in New Jersey. CF causes the body to produce thick, sticky mucus that clogs the lungs and digestive system, which can lead to life-threatening infections. CF care is grounded in evidence-based clinical guidelines and as a complex, multi-system disease without a cure, CF requires an intensive treatment regimen including multiple medications. For people with CF, it is not uncommon to take seven therapies every day, and as many as twenty. Many medications are taken year after year, and in most cases, for life. While these therapies are helping people live longer, healthier lives, we also know patients often encounter barriers to accessing them.
Prior Authorizations for People with CF
Prior authorizations are one of the obstacles that people living with chronic conditions, including CF, must navigate when accessing care. These requirements can delay the start or continuation of needed treatments, which can lead to adverse health outcomes. In a 2022 survey by the American Medical Association, 94% of physicians reported that prior authorizations led to delays in necessary care for their patients whose treatment required PA and 80% reported that PAs have led to patients abandoning their treatment at some point. Because CF is a progressive disease, patients who delay or forgo treatment — even for as little as a few days — face increased risk of lung exacerbations, costly hospitalizations, and potentially irreversible lung damage.
PAs can also cause significant administrative burden for CF providers and are often redundant for medications that people with CF must take indefinitely to maintain their health. In a CF Foundation survey of CF care teams, 58 percent of providers reported spending 20 percent or more of their time on PAs in 2016. This arduous process diverts valuable time and resources away from direct patient care.
We appreciate New Jersey’s attention to this issue and support the following provisions in A1255:
Medications for Chronic Diseases
Recognizing that people with CF and other lifelong, chronic diseases take the same drugs for most of their lives, we appreciate A1255 exempts health care medications and services to treat chronic and long-term care conditions from repeat authorizations and requires insurers to honor a prior authorization approval for the duration of the treatment. Eliminating unnecessary repeat authorizations will help promote immediate and consistent access to life-saving therapies for people with CF, and significantly reduce administrative burden for CF care teams.
Response Times and Continuity of Care
A1255 requires health plans to respond to all prior authorization requests within one calendar day for covered medications and services or 24 hours for urgent medications and services, thereby ensuring timely access to treatments. Also included in the bill is a continuity of care provision that requires payers to continue to honor an existing PA for at least 60 days when patients switch health plans or honor it indefinitely when there are changes in coverage for a given treatment. As stated previously, CF maintenance requires many chronic medications, and gaps in therapy put people with CF at increased risk of costly hospitalizations and negative health outcomes. We support efforts to reduce delays in care and ensure people have timely access to their necessary medications.
Evidence-Based Review
One of the purposes of prior authorization is to verify the clinical appropriateness of a service, so it is crucial that payers use evidence-based criteria when developing prior authorization requirements. CF treatments have very clear indications established by the Food and Drug Administration and it is essential that prior authorization criteria reflect the data and label approval. To that end, A1255 requires that PA denials must be made by a licensed physician who specializes in managing the medical condition or has experience providing the requested service.
The CF Foundation appreciates that PA policies were adopted to ensure patients only receive medically necessary care, and we understand the challenge payers face in managing medication utilization and cost. However, utilization management cannot come at the expense of delays in patient access to needed care. A1255 provides an opportunity to make prior authorization processes more transparent, efficient, and evidence-based, allowing for timely access to appropriate treatments. The Foundation and the undersigned New Jersey CF care team members urge you to pass A1255 before the end of the legislative session.