A bill sponsored by the California Medical Association (CMA) that would reform the prior authorization process advanced out of the Assembly Health Committee on July 11.

SB 598, authored by Senator Nancy Skinner, would institute a one-year “gold card” exemption program from prior authorization requirements for physicians who have at least a 90% prior authorization approval rate. The bill would also allow physicians to have appeals of their prior authorization denials reviewed by a licensed health professional of the same or similar specialty.  

At the Assembly Health Committee hearing, witnesses provided testimony about the severe adverse impacts they and their loved ones experienced due to prior authorization.

Ocean McIntyre, a space science communicator, testified about how a disorder called idiopathic intracranial hypertension caused her to lose “my vision, my independence, my ability to work, and ultimately my life as I knew it.”

“But it wasn’t just my condition that caused me to lose my vision,” McIntryre said. “It was also the countless delays obtaining treatment that I encountered … I have to live the rest of my life with the effects of prior authorization.

“Had I been allowed to get the care that I needed when I needed, I would still be able to drive a car, fly a plane, look through a telescope, see colors, or walk without a cane. But I can’t, and I never will be able to do those things again.”

After discussing how being denied care caused her and her daughter to be homeless due to her inability to work, McIntyre added, “I know that I am not unique, and there are countless others who have gone through similar experiences and far worse because of prior authorization…Being repeatedly denied care made me feel like I wasn’t important – that my life wasn’t important. And no one should be left feeling helpless and hopeless as they lose their health, quality of life and even their very life itself.” (See McIntyre’s full testimony in the clip below.)

Also testifying was Vivian Gonzales, a public health nurse, detailed how she sought care for her father’s metastatic melanoma and hoped that her father’s team of specialists would be able to take swift action.

“But my dad’s health plan made that impossible,” Gonzales said. "Virtually every treatment and test his doctors said he needed required prior authorization.”

The obstacle course of prior authorization denials she and her father encountered persisted throughout the entirety of their quest for care. “We didn’t give up hope, we got a referral for… radiation therapy. The referral was denied, appealed, and overturned. But it was too late. My father passed away April 27, 2022.”

“Nobody should have to experience the stress, frustration and pain we went through,” Gonzales continued. “That is why SB 598 is so important. It allows patients like my dad to get the treatment they urgently need without unnecessary delays.”  (See Gonzales’s full testimony in the clip below.)

SB 598 is part of CMA’s 2023 priority bill package and builds upon the momentum CMA built with a similar bill (SB 250) authored by then-Senator Richard Pan, M.D. in the prior legislative session.

Share Your Story

You can help CMA advocate for SB 598 by sharing your story with us. We want to hear from patients and physicians who have experienced delays in care because of the broken prior authorization process. Click here to add your voice to help reform the prior authorization process to ensure that patients receive the care they need — when they need it.