An attempt to limit insurers’ use of prior authorization is expected to be a top priority this session for a bipartisan group of North Carolina state lawmakers. That’s likely to provoke a battle with state health insurers, who say it’s an essential tool to help control health care costs.

*This report first appeared on WRAL on January 29, 2025, by Laura Leslie, WRAL capitol bureau chief

An attempt to limit insurers’ ability to require advance approval before covering a patient’s medical care is expected to be a top priority this legislative session for a bipartisan group of North Carolina lawmakers — an effort likely to provoke a battle with state health insurers, who say it’s an essential tool to help control health care costs.

But doctors say the practice, known as prior authorization, comes with its own set of costs, and for some patients and families, it’s about much more than dollars.

That’s the case for Amanda Watson. Diagnosed with Stage 4 metastatic breast cancer in 2023, she’s been through more than a year of painful and debilitating chemotherapy, radiation and surgery — all to buy a little more time with her young sons, Judson and John William.

Instead, she’s spending hours each day on the phone, fighting to get insurance approval for the medical care she and her doctor say she needs.

“What kind of cost can you put on the time with your children or family when you’re being told your days are limited?” Watson told WRAL News. “I could have spent that time in a different way that would be more meaningful to my family, my boys.”

Watson told her story at a news conference Tuesday, held by lawmakers and doctors who say prior authorization has gotten out of hand.

Dr. John Meier, president of the North Carolina Medical Society, said prior authorization began as a tool for complex medical cases, but it’s now being required for routine needs like scans, tests and even some generic drugs.

More than 95% of doctors’ requests are eventually approved, Meier said, but at a tremendous cost to doctors and patients.

“It becomes a game of chicken,” Meier said. “Who’s going to wear out? Who’s going to drop the ball first?”

State Rep. Grant Campbell, R-Cabarrus, is a practicing OB-GYN and Watson’s former doctor. He said prior authorization is about helping insurers’ bottom line, not patients.

“This is about delaying care,” Campbell said. “This is about forcing patients and physicians to settle for cheaper, less effective care, or ultimately hoping the patient gives up and pays out of pocket.”

Campbell, fellow Rep. Dr. Tim Reeder, R-Pitt, and other lawmakers are pushing to pass reforms this year they say will benefit patients. The proposal is likely to be similar to a bill that passed the House in 2023 but failed to pass the Senate. This time, they say, they believe they have backing in the Senate as well.

Health insurers say prior authorization helps them control costs and reduce waste in the healthcare system. Restricting it, they say, could lead to higher costs for patients.

Peter Daniel, executive director of the North Carolina Association of Health Plans, says insurers are willing to work with stakeholders and lawmakers on “meaningful regulatory reforms.”

“We all share the same goals of bringing costs down while improving quality of patient care,” said Daniel, whose group represents the state’s insurers.

Watson says the current system has its costs, too, for patients like her.

“It makes you question everything about your being,” Watson said. “It makes you wonder, ‘Am I worth fighting for? Is this fight worth it?’”

Daniel declined to comment on Watson’s case, but called it a “horrible situation.”

“We stand ready to try to find solutions to very vexing problems,” Daniel said.