2025-04

Removing Prior Authorization from Medications for Chronic Conditions

Sponsored by

Sen. Cristina Castro (IL), Rep. Geraldo Reyes (CT),
Rep. Susan Valdes (FL), Rep. Louis Ruiz (KS) and
Sen. Flavio Bravo (AZ)

Reported to the Caucus by the
NHCSL Healthcare Task Force

Rep. Alma Hernández (AZ), Chair

Unanimously ratified by the Caucus on November 22, 2025

WHEREAS, treatment regimens for chronic conditions such as multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, diabetes type 1, diabetes type 2, or pre-diabetes are often established for well over one year and stabilize or improve the condition essentially indefinitely; and,

WHEREAS, unless the FDA has issued a statement about a previously approved drug that calls into question the clinical safety of the drug, prior authorization for a well-established medication regimen only serves to inconvenience the patient or interrupt the regimen, endangering the health of the patient; and,

WHEREAS, a physicians’ survey by the American Medical Association showed that prior authorization wreaks havoc on patient care by substituting “prior authorization wreaks havoc on patient care” leading to serious, life-threatening or even deadly events for patients, unnecessary waste, and physician burnout;[1] and,

WHEREAS, a robust majority of doctors (61%) report that they are concerned that augmented or artificial intelligence (AI) increases or will increase prior authorization denial rates;[2] and,

WHEREAS, the same socioeconomic and structural barriers that make Hispanic Americans the least likely to have health insurance of any major racial or ethnic group,^[3] make prior authorization of drug dispensing by insurers especially fraught for that population.

THEREFORE, BE IT RESOLVED, that the National Hispanic Caucus of State Legislators (NHCSL) calls on state legislatures to enact prohibitions on prior authorization for medications in a regimen established for one year or more to treat a chronic health condition in a patient; and,

BE IT FURTHER RESOLVED, that NHCSL calls on state legislatures to enact prohibitions on the use of AI for any prior authorization determinations if its use increases denial rates.

IN ITS MEETING OF MARCH 28, 2025, THE NHCSL HEALTHCARE TASK FORCE UNANIMOUSLY RECOMMENDED THIS RESOLUTION TO THE EXECUTIVE COMMITTEE FOR APPROVAL.

THE NHCSL EXECUTIVE COMMITTEE UNANIMOUSLY APPROVED THIS RESOLUTION ON APRIL 4, 2025, AT ITS MEETING IN WASHINGTON, DC.

THE NATIONAL HISPANIC CAUCUS OF STATE LEGISLATORS UNANIMOUSLY RATIFIED THIS RESOLUTION AT ITS ANNUAL MEETING OF NOVEMBER 22, 2025, IN OKLAHOMA CITY, OKLAHOMA.

[1] American Medical Association, AMA survey indicates prior authorization wreaks havoc on patient care (Jun 18, 2024).

[2] Ibid.

[3] Assistant Secretary of Planning and Evaluation Office of Health Policy. Health Insurance Coverage and Access to Care Among Latino Americans: Recent Trends and Key Challenges. June 7, 2024. https://aspe.hhs.gov/sites/default/files/documents/819559944370d2e8a24dc5bc38da6c7b/aspe-coverage-access-latinos-ib.pdf