(L-R Back Row: NCMS Interim CEO Steve Keene, NCMS BOD Member Dr. Ronnie Laney, NCMS President Dr. John Meier, Josh Dobson. Front Row: Lindsi Franklin, Rep. Timothy Reeder, MD, Rep. Grant Campbell, MD, Rep. John Bell, NCMS Board Member Dr. Charul Haugan, Sumathi Iyendar)
The CARE FIRST Act Looks to Reform Prior Authorization in North Carolina
RALEIGH, March 18, 2025 — With the wellbeing of North Carolinians and their physicians at the top of its list of priorities, the North Carolina Medical Society (NCMS) showed support for The CARE FIRST Act, which would reform the process of patients seeking prior authorization from their health insurance provider. NCMS firmly believes that physicians should be the ones to make medical decisions for their patients and health insurance companies should take responsibility for the outcome of denied medically necessary care.
Interim NCMS CEO Steve Keene said, “The health of North Carolinians is the main priority of NCMS. When unnecessary prior authorization delays treatment or denies medically necessary care, patient health is negatively affected. I am pleased that legislators are starting this important conversation to safeguard patient-doctor relationships.”
Health care professionals and NCMS members alike shared their personal experiences navigating the ramifications of prior authorization. John Meier, MD, President of the North Carolina Medical Society and internal medicine physician, spoke in support of The CARE FIRST Act saying, “On multiple occasions, my patients have suffered because of the delays of unnecessary prior authorization. It is critical that prior authorization in NC is reformed so that patients receive timely, necessary, and consistent care that is not delayed nor withdrawn retrospectively.”
Linsi Franklin, the mother of a 9-year-old boy who was diagnosed with severe Crohn’s disease, struggled to get prior approval for her son who needed two life-saving surgeries and two rounds of Humira. “While I’m so thankful that we finally were able to receive Isaac’s medication, I was shocked at the time it took to get my son the medication he needed. His immune system was actively attacking his intestines. He was also dealing with the psychological and physical challenges of having an ostomy bag. He had a team of physicians fighting for him, and it still took months to get Isaac the medication he needed. Isaac shouldn’t have had to wait. A child and their parents shouldn’t have to fight that hard to get needed medications and treatments.” She continued at the press conference stating, “For weeks, I would spend hours on the phone daily with the insurance company and the pharmacy, trying to push the prior authorization through. This is especially difficult when you have three small children at home. I am fighting for prior authorization reform in North Carolina because my son, other ten-year-olds, and other families in North Carolina shouldn’t have to.”
Sumathi Iyengar, the Co-Founder and Executive Director of the Wiskott-Aldrich Foundation, shared the prior authorization stories of her son and a 20-year-old UNCG student named Camden who suffers from Wiskott-Aldrich Syndrome (WAS). “It is paramount that prior authorization be reformed in NC so that patients like Camden have a straightforward and easy to understand process where his treatment is approved without these obstacles. Unfortunately, Camden is not alone; I hear the same story repeated time and again. We should do better by John, by our children, our families who are fighting so hard to do their best.”
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Click here for full press conference video
Click here for a link to House Bill 434