When Dr. Mark Lewis told me about his patient, I understood immediately why this matters. The patient had been diagnosed with pancreatic cancer. Dr. Lewis determined the appropriate chemotherapy and prescribed a standard anti-nausea medication so they could tolerate the aggressive treatment ahead. It was not experimental. It was not unusual. It was the right call.
But it did not start right away.
Not because the doctor changed his mind.
Not because of medical concerns.
Because of paperwork.
The insurer required prior authorization. The request triggered review, follow-up documentation and delay. For a patient beginning cancer treatment, time is not abstract. It matters.
A system that has drifted
Prior authorization was designed to prevent misuse and protect policyholders. That purpose is legitimate. But what began as a targeted safeguard has expanded into a broad administrative system affecting routine medications, imaging and outpatient care already supported by established clinical guidelines.
A 2024 survey from the American Medical Association found that 94% of physicians report that prior authorization delays necessary care. Nearly one in three report delays of several weeks or longer. For patients with cancer, heart disease or serious chronic illness, those weeks can mean complications, additional procedures and preventable costs.
When oversight becomes opaque and unpredictable, it stops protecting patients and starts shifting risk and stress onto families.
What SB319 Does
This session I am sponsoring SB319 to establish enforceable standards without eliminating prior authorization.
Insurers must post their authorization requirements in plain language. Utahns should not have to guess what criteria determine whether their care is approved.
If artificial intelligence is used to review authorization requests, that use must be disclosed. When algorithms influence coverage decisions, transparency is required.
The bill sets firm timelines: five business days for standard requests and 72 hours for urgent care. Insurers are free to review. They are not free to stall.
Clinical denials must reflect independent medical judgment, not automated screening or unchecked recommendations. When care is denied on medical grounds, that decision must come from accountable professional evaluation.
SB319 also protects continuity of care for patients with chronic conditions by reducing repetitive reauthorization cycles for stable treatment plans. And it requires public reporting to the Utah Insurance Department so approval rates, denial rates, appeal outcomes and processing times are measurable and visible.
Oversight should protect, not delay
This reform disciplines prior authorization. It does not dismantle it.
Oversight should prevent waste, not create it. It should ensure responsible use of resources, not force patients to navigate procedural barriers during life-altering diagnoses.
Dr. Lewis’s patient eventually received their medication. But timely care should not depend on persistence or on having a physician willing to fight through an opaque process.
Utah families deserve transparency. They deserve timely decisions. They deserve decisions grounded in accountable medical judgment.
SB319 makes that standard enforceable under Utah law.