Montana legislators’ prior authorization reform push mirrors national trends

Editor's Note

Montana legislators are moving to restrict health insurers’ use of prior authorization as frustration over the practice mounts nationwide, KFF News reported February 13.

The outlet reports that two Democratic and Republican lawmakers have introduced or are drafting bills for the 2025 Montana Legislature to limit these insurer-mandated approvals, which are frequently blamed for delaying critical treatments and medications. One proposed measure would prevent insurers from requiring prior authorization for most generic drugs, inhalers, and insulin. Another would prohibit insurers from denying a medication if a patient is waiting for approval under a new insurance plan. A separate bill requires insurers to approve or deny coverage of biologic treatments for children with chronic conditions within seven days or have the treatment automatically approved.

While insurers maintain that prior authorization helps control healthcare costs and prevent unnecessary procedures, critics say the system prioritizes financial interests over patient well-being. As detailed in the article, many physicians who say the practice contributes to burnout = report spending hours each week securing approvals instead of seeing patients, delaying access to necessary treatments.

The push for reform mirrors national trends, KFF reports. In the past two years, multiple states have enacted laws restricting prior authorization, often by shortening approval timelines or requiring that denials be made by physicians with matching specialties. In January, New Jersey became the latest state to pass such legislation, and lawmakers in several others—including Indiana, Nebraska, and Virginia—are considering similar measures this year. Additionally, Cigna recently pledged a $150 million investment to streamline its prior authorization process following widespread backlash against insurer-driven treatment delays.