YesOn766

If you are one of the many Vermonters with a health condition yourself or supporting a family member who needs to use their insurance benefits, H. 766 may help you access health care!

Contact the Governor at 802-828-3333 to ask for his support today!

What H. 766 does:

Requires health plans to respond to urgent prior authorization requests within 24 hours – meaning less time waiting for an answer about live-saving medical services;
If you are on ongoing, chronic medications, you will get to continue on your medication or treatment for five years without going through prior authorization again – instead of every year – saving you and your doctor time and stress each year;
If you are stable on a medication, you or your provider can request to stay on it rather than going back through “step therapy” or “fail first” policies, which require a patient to try and fail one or more medications before they can access the medication actually recommended and prescribed by their healthcare provider;
Allows you to access at least one readily available asthma controller medication without prior authorization– addressing a crisis in pediatrics right now where kids can’t obtain medication to help them breath and are ending up in the ED;
Allows your primary care provider to order your tests, imaging and procedures with no prior authorization;
If you switch to a new health plan, they will have to let you continue on a stable medication or treatment for at least 90 days.
Read the text of the bill that passed the legislature here.
FAQ on H. 766

Call 802-828-3333 or email https://vermontce.my.vermont.gov/s/governor-office-ce

H. 766 will reduce insurance company delays and denials. Ask for Governor Scott’s support to keep insurance companies from coming between you and your doctor!

** Note that these changes will only apply to private health plans regulated by the State, not Medicaid, Medicare or large group health plans.

Read more here about how reducing insurance hurdles can reduce costs to the health care system:

Added health care costs because of prior authorization & step therapy: For example, sending patients to the ER for advanced imaging because requests from primary care providers are denied.

“I have resorted to sending anyone who needs same-day imaging to the ER because I know that medically the care should not be delayed. I do not send them for a consult, or because I am unsure of the workup or medicine. I literally send them for a study I cannot order. By seeing a patient in my clinic, determining the need for advanced imaging, and then sending them to the ER, I know and accept that I have taken up unnecessary resources. I know that the patient will get another bill for emergency room services.” - Katie Marvin, MD, Family Physician, Lamoille County[i]

These costs are hurting patients: A recent KFF study[ii] found that one-quarter of adults whose insurance problems included prior authorization problems said their health status declined as a direct result of problems they had with their health insurance, while one-third said access to needed care was delayed or denied, and more than one-third said it resulted in higher out-of-pocket costs.

“I have an 11-year-old patient with such severe behavioral problems that he cannot safely be in school without his medication. He’s had a remarkable sustained response to medication, which allows him to attend school and learn. His mother changed insurance, and they won’t cover the medication until he has tried and failed two other medications." - Fay Homan, M.D, Family Physician, Wells River, VT[iii]

Added administrative costs to the health care system: costs of vendors, technology, and staff to process paperwork, staff turnover and burnout from prior authorization, step therapy and processing insurance claims. One estimate is that the administrative costs range anywhere from $20 per prior authorization up to $75 for payers and providers depending on the workflow.[iv]

"Insurance companies will argue and show cherry-picked data that demonstrate cost savings and/or no harm. Their figures rarely if ever account for direct or indirect costs to patients, providers, the contribution to burnout, repeat visits when their alternative ‘recommended’ therapy does not work, or overcrowding and overuse of emergency access when this is the path of least resistance for urgent needed testing or urgent needed treatment." - Phillip Skidd, M.D., Neuro-ophthalmologist at UVMMC

Contact the Governor to ask for his support of H.766 today!

Call 802-828-3333 or email https://vermontce.my.vermont.gov/s/governor-office-ce

Click here for a poster and a social media graphic to use to share information on H. 766.