What is gold carding?

Although it might sound like a good thing to get a gold card, in the healthcare industry it can be very dangerous. Gold carding, as it’s known in medical terms, is exempting health care providers who have a certain rate of prior authorization approval for health care provider services from prior authorization requirements. Prior authorizations for prescription drugs are used to encourage the appropriate use of medications, to assist in the reduction of drug costs for all beneficiaries and to promote evidence-based drug therapy utilizations. Prior authorizations are developed by Pharmacy &Therapeutic committees using information from the FDA, drug manufacturers, medical literature and through consultations with practicing physicians and appropriate professional organizations. These committees are typically composed of doctors, pharmacists and other qualified health professionals and committees who help to develop guidelines for prior authorization based on the plan’s unique patient population.

During the opioid epidemic, prior authorizations have been one of the primary tools in ensuring appropriate opioid utilization. Beyond opioids, many drugs have harmful side effects or interact adversely with other medications. Prior authorizations help ensure appropriate utilization when there are potential safety concerns or complex clinical concerns associated with utilization of a certain drug. A provider’s “gold card” status should not

exempt them from a plan’s ability to implement additional safety checks that are currently in place to ensure appropriate and safe medication utilization.

The fundamental goal of these tools is to promote the appropriate and cost-effective use of medications, “gold carding” would remove this tool. There is growing concern that Tennessee will propose legislation next year that would allow gold carding. Giving certain physicians the sole power to prescribe without the oversight of this vast and knowledgeable network. As patients who could be adversely affected by this, it’s important to be watchful of these pieces of legislation and make our lawmakers know we don’t agree with this potentially dangerous and costly proposal.