BISMARCK, N.D. – Navigating the process of prior authorization for medical care can be incredibly complex. Essentially, it means that your insurance provider must approve certain treatments or medications before your healthcare provider can prescribe them.
Carrie Varner, a North Dakota resident, recently shared her experience with KFYR Reporter Elizabeth Shores. Varner, who suffers from severe asthma, used to experience multiple attacks weekly before starting Xolair, an injectable medication. Without insurance, the monthly cost of Xolair is nearly $60,000. Although her doctors helped her apply for a manufacturer’s discount, the request was denied, increasing her co-pay to approximately $2,600 per month. “It’s just going to be like, ‘Okay, what’s going to set it off today? What’s going to make it so that it’s a fatal issue? What’s going to make it so that I don’t have much of a quality of life anymore?’” Varner stated.
Before she could start Xolair, Varner underwent months of appeals between her doctors and her insurance company, with her prior authorization requests denied eight times. She anticipates having to go through the process again if she hopes to resume the medication. Additionally, Dr. Alfredo Iardino, a pulmonologist at CHI St. Alexius in Bismarck, noted this problem affects nearly all his patients. “It basically will increase their chances of coming to the hospital, increase their chances of serious complications, and in my case, in the respiratory world, end up with a COPD or asthma exacerbation in the ICU,” Iardino said.
Tim Blasl, President of the North Dakota Hospital Association, explains that many insurance companies already collaborate with doctors and follow standard procedures regarding medical service authorizations. According to Blasl, the new bill would require insurance providers to respond to consumers’ authorization decisions within a specific timeframe, potentially providing automatic claim approvals if the companies do not respond promptly. “This makes it a little more standard, and so all the insurance companies have to follow this, again, in terms of commercial. So, that just helps people that are seeking prior authorization. There’s some consistency because there is no consistency today,” Blasl said.
Representatives from Blue Cross Blue Shield testified that prior authorization functions as a crucial safety measure. They stated it confirms with the provider that the recommended treatments are safe, medically sound, and not redundant. Despite their assertion that it’s a necessary inconvenience to ensure evidence-based care, time is of the essence for patients like Varner.
Multiple insurance company representatives were contacted for comment, but no responses have been received. Since exhausting her medication, Varner has mostly remained homebound. Having already passed the Senate earlier this month, the bill will now be considered by the House. Copyright 2025 KFYR. All rights reserved.
