Dear Chairman Bailey and Members of the Committee on Health Coverage, Insurance, and Financial Services:
On behalf of the more than 270 people living with cystic fibrosis in Maine, we write to express our support for LD 1496 (Zager), which requires prior authorizations for health care services to remain valid for at least one year and protects patients from experiencing care delays during changes in coverage. 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 and enhance efficiency of the process.
About Cystic Fibrosis
Cystic fibrosis is a progressive, genetic disease that affects the lungs, pancreas, and other organs. There are close to 40,000 children and adults living with cystic fibrosis in the United States, and CF can affect people of every racial and ethnic group. 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 20. Many medications are taken year after year, and in most cases, for life. While advances in CF care are helping people live longer, healthier lives, we also know that the cost of care is a barrier for many people with the disease.
Prior Authorization Reform
Prior authorizations are one of the obstacles people with 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 2023 survey by the American Medical Association, 94 percent of physicians reported that prior authorizations led to delays in necessary care for their patients whose treatment required PA and nearly 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 a 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% of providers reported spending 20% or more of their time on PAs in 2016. This arduous process diverts valuable time and resources away from direct patient care.
The Foundation understands that payers adopt prior authorization policies to ensure patients only receive medically necessary care, and we recognize the challenge insurers face in managing medication utilization and cost. However, utilization management cannot come at the expense of delays in patient access to needed care. LD 1496 provides an opportunity to make prior authorization processes more efficient, allowing for timely access to appropriate treatments. We appreciate Maine’s attention to this issue and support the following provisions in LD 1496:
Medications for Chronic Diseases
Recognizing that people living with CF and other lifelong, chronic diseases take the same drugs for most of their lives, we appreciate that LD 1496 requires insurers to honor prior authorization approvals for drugs and therapies used to treat chronic and long-term conditions for the duration of the treatment or one year, whichever is longer. Additionally, if a treatment is necessary for more than one year, the bill prohibits plans from requiring repeat authorizations more frequently than once every five years. Eliminating unnecessary repeat authorizations will help promote immediate and consistent access to life-saving therapies for people with CF and significantly reduce the administrative burden for CF care teams.
Continuity of Care
LD 1496 includes a continuity of care provision that protects patients from experiencing care delays when there are changes in coverage for a given treatment or when patients switch health plans. 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.
Conclusion
The Cystic Fibrosis Foundation understands the challenge insurers face in managing medication utilization and the rising cost of health care. However, utilization management strategies that further burden patients and providers are unacceptable and cannot come at the expense of delays in patient access to needed care. LD 1496 provides an opportunity to make prior authorization processes more transparent, efficient, and evidence-based, allowing for timely access to appropriate treatments.