Every day across North Carolina, patients face a barrier to getting the care they need: prior authorization. For thousands of North Carolinians, these insurance approval processes mean waiting for critical treatments, procedures, and medications—sometimes with life-altering consequences.

How House Bill 434 Could Change Patient Care in North Carolina

The North Carolina legislature is currently considering House Bill 434, aptly named the "Care First" Act. This legislation directly addresses a significant obstacle preventing patients from receiving timely care: the complex and often-delayed prior authorization process.

For North Carolina patients, the potential benefits are immediate and substantial:

  • Faster access to needed treatments: By streamlining approval processes, patients could receive care when they need it, not weeks later when conditions may have worsened.
  • Reduced treatment abandonment: When approvals take too long, many patients simply give up—a problem this bill directly addresses.
  • More equitable care access: Current prior authorization processes often disproportionately affect rural North Carolinians and those with chronic conditions.

    • Why North Carolina Patients Need Prior Authorization Reform Now

    The current prior authorization landscape creates significant barriers to care:

  • Patients having to wait weeks for approval of diagnostic tests while their condition deteriorates.
  • Families in rural communities driving hours to see a specialist, only to learn the recommended treatment requires an authorization that will take weeks.
  • Patients who can't afford to pay out-of-pocket for medications while waiting for insurance approval, so they forego filling needed prescriptions.

    • These scenarios play out daily across our state. When patients face delays in receiving care, their health outcomes worsen, their quality of life suffers, and healthcare becomes more expensive for everyone.

    How the "Care First" Act Transforms the Patient Experience

    House Bill 434 introduces several key changes that directly benefit patients:

    Faster Decisions on Care

    Under the proposed legislation, insurance companies would need to complete reviews more quickly and transparently. For patients, this means less time spent waiting and wondering if treatment will be approved.

    Reduced Prior Authorizations Needed in the First Place

    The bill would streamline which treatments require prior approval and standardize the process. Patients would face fewer hurdles when seeking care that their doctors have recommended.

    Care Decisions Based on Patient Needs

    By clarifying how "medical necessity" is defined, the legislation would reduce inappropriate denials of care that patients genuinely need, allowing medical professionals to make decisions based on patient needs rather than administrative criteria.

    The Human Impact: Real Benefits for North Carolina Families

    The practical effects of this legislation would be felt by patients in every corner of North Carolina:

  • A mother could receive approval for her child's specialized therapy within days instead of weeks.
  • A senior would face fewer disruptions in medication coverage.
  • Patients would spend less time on the phone with insurance companies and more time focusing on recovery.

    • When patients receive timely care, their outcomes improve, and healthcare costs decrease over the long term. More importantly? When artificial barriers no longer stand between patients and their doctors, their relationship transforms into a partnership built on mutual trust and shared decision-making.

    Looking Forward: What's Next for the "Care First" Act

    As this legislation moves through the North Carolina General Assembly, patients across the state have a stake in its success. The bill would still need to move through several legislative steps before becoming law, including committee reviews and votes in both chambers.

    By supporting the "Care First" Act, North Carolina can move closer to ensuring that when patients need care, they receive it. The Novant Center for Public Policy Solutions will continue monitoring this legislation and promoting policies that improve healthcare access for all North Carolinians.

    The Novant Center for Public Policy Solutions identifies healthcare policy issues that directly affect patient care and advocates for meaningful reform. Our policy recommendations are informed by frontline healthcare experience and focused on improving outcomes for patients.