STATE HOUSE – The Senate approved legislation this week sponsored by Senate Health and Human Services Committee Chairwoman Melissa Murray to prohibit insurers from requiring prior authorization for medically necessary health care services and prescriptions ordered by patients’ primary care providers.
The bill – 2025-S 0168A – is part of a nine-bill package of legislation Senate leadership has endorsed this session to address health care accessibility and affordability.
“It is the health care providers, not insurers, who know best what care is needed for their patients. And we need our primary care providers focused on providing care, not haggling with insurance companies,” said Murray, a Democrat representing District 24 in Woonsocket and North Smithfield.
The legislation would prohibit insurers from imposing prior authorization requirements for any admission, item, service, treatment, test, exam study, procedure or prescription drug ordered by an in-network primary care provider, including general internists, family physicians, pediatricians, geriatricians, OB-GYNs, nurse practitioners, physician assistants and other health care providers who are licensed to provide, coordinate, and supervise primary care and order health care services and goods, including preventive and diagnostic services for patients.
It would not apply to prescriptions for controlled substances, and provides an exception for insurers to impose prior authorization requirements for individual primary care providers who have a documented history of fraud, waste or abuse.
If enacted, the bill would take effect Jan. 1, 2026. The legislation now goes to the House, where a similar bill – 2025-H 5120 – is sponsored by Rep. Brandon Potter of Cranston.
According to the American Medical Association, which has been advocating to reduce prior authorization requirements, the average physician practice completes 45 prior authorizations per physician per week. According to the most recent AMA survey, 94 percent of physicians believe prior authorization delays care. The Rhode Island Medical Society has also advocated for reductions in prior authorization requirements.
