2 RI Lawmakers Propose Ending Prior Authorization Requirements For Primary Care Providers

CRANSTON, RI — Two Rhode Island lawmakers have introduced a bill to prohibit health insurers from requiring prior authorization for treatment and services ordered by a patient's primary care provider.

State Rep. Brandon Potter (D-Cranston), and state Sen. Linda Ujifusa (D-Portsmouth, Bristol) sponsored 2025-H 5120 this week, intending to help patients access the care they need in a timely manner while also decreasing the administrative burden on primary care providers.

"Prior authorization is a tool used by insurance corporations to block patients from getting what their doctors ordered," Ujifusa said. "It’s based on the false assumption that doctors and patients 'over-utilize' goods and services and need to be 'managed' by private insurers. In fact, requiring PCP prior authorizations delays or prevents patients from getting tests and treatments — making diseases harder to treat or requiring trips to the emergency room. This bill allows PCPs to spend more time caring for patients, not fighting for permission from corporations who profit from limiting care."

Potter said freeing primary care providers from administrative burdens posed by prior authorization requirements is especially important, because Rhode Island struggles with a shortage of those type of doctors.

"We know all too well that Rhode Islanders are struggling to find primary care doctors, and those fortunate enough to have one are facing longer waits for appointments," Potter said. "The situation is only made worse when doctors have to spend their time battling insurance companies instead of treating patients. This is a step to ease that burden, expand access to basic health care, and ensure medical decisions are made by doctors based on what’s best for patients — not by insurance companies prioritizing their bottom line."

The legislation would prohibit insurers from imposing prior authorization requirements for any admission, item, service, treatment, or procedure 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.

If approved, the bill would take effect July 1, 2026.

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.

"This legislation is a step in the right direction to address the significant challenges physicians face due to prior authorization requirements," Rhode Island Medical Society President Kara Stavros said. "These burdens delay care, increase administrative strain, and ultimately impact patient outcomes. We appreciate the leadership of Representative Potter and Senator Ujifusa in tackling this issue and remain committed to advocating for further reforms that support timely, patient-centered care."

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