West Virginia Changes Prior Authorization Law After Man's Treatment Delay and Death

West Virginia Governor Patrick Morrisey signed a new law yesterday that will offer greater flexibility for state workers and beneficiaries on their health plan when they run into roadblocks that a recent poll found is the biggest barrier to care.¹

The legislation affects 215,000 members of the Public Employees Insurance Agency. Under the law that takes effect June 10, 2026, if members are approved for a course of treatment, they will be able to pursue an alternative, medically appropriate treatment of equal or lesser value without the need for separate approval from the state health plan.

“This legislation is rooted in a simple principle,” Morrisey, a Republican, said in a statement. “If a treatment has already been approved, patients should be able to pursue a medically appropriate alternative without being forced to start the process over again—especially when it does not cost more. We owe it to our people to make sure the system puts patients first.”

Although HB 4965 was billed as a victory for “patient choice,” the story behind it has to do with prior authorization (PA), which a February KFF Health Tracking Poll found creates more challenges for patients navigating the health care system than finding a doctor, scheduling an appointment, or even paying for care.²

Once PA is obtained, and medical need demonstrated, patients can skip the “do-over” if a second, medically appropriate option emerges at the same or lower cost. “This is about common sense, compassion, and trusting patients and their doctors to make the best decisions for their care,” Morrisey said.

The law was inspired by the case of Eric Tennant, a coal mining safety instructor who died in September 2025 of cancer at aged 58 years. According to extensive reporting by KFF News and NBC, Tennant’s physicians recommended a $50,000 treatment, histotripsy, that would target a large tumor on his liver with ultrasound waves, with the aim to shrink it and extend his life.³ The procedure was deemed “experimental and investigational” and denied for months. It was finally approved after Tennant’s condition had deteriorated to the point that he was no longer a good candidate.

PA has become bipartisan flash point, so much so that the nation’s major insurers gathered in Washington, DC, last summer with Health and Human Services (HHS) Secretary Robert F. Kennedy Jr and CMS Administrator Mehmet Oz, MD, MBA, pledging to make several reforms by this year to lighten the burden for patients and physicians alike.⁴ The burden of PA is especially acute in cancer care because the time needed to make appeals can be deadly, as seen in the Tennant case. As of June 2025, the American Society of Clinical Oncology reported that 30 states had taken up legislation to regulate PA⁵; West Virginia’s bill passed the legislature in March.³

The Community Oncology Alliance (COA), which represents independent oncology practices, has taken an official position on PA, both regarding procedures and for use of therapies, as follows:

“COA opposes the use of prior authorization for certain cancer treatments, as it delays important treatment, wastes valuable physician and staff time, and inserts bureaucratic review of treatment decisions by those who are often neither oncologists nor physicians. While prior authorization may have a place for certain nonstandard treatments, it should not be required for treatments that follow recognized pathways or clinical care guidelines. COA advocates for a complete reexamination and overhaul of the prior authorization system.”⁶

COA’s February 2026 survey on utilization management, which includes PA, found the following⁷:

• 96.6% said “insurance company policies interfere with patients accessing the treatment their physician recommends first”
• 89.3% reported having to add staff over the last 5 years solely to manage insurance company and pharmacy benefit manager paperwork
• 86.9% believe that “current appeals processes are not adequate or reasonable”

References

1. Governor Morrisey signs HB 4965 to expand patient choice. WV.gov. March 31, 2026. Accessed April 1, 2026. https://governor.wv.gov/article/gov-morrisey-signs-hb-4965-expand-patient-choice
2. Kirzinger A, Montalvo J, Hamel L. KFF Health tracking poll: prior authorizations rank as public’s biggest burden when getting health care. KFF. February 2, 2026. Accessed March 15, 2026. https://www.kff.org/public-opinion/kff-health-tracking-poll-prior-authorizations-rank-as-publics-biggest-burden-when-getting-health-care/
3. Sausser L. After man’s death following insurance denials, West Virginia tackles prior authorization. KFF Health News. April 1, 2026. Accessed April 1, 2026. https://kffhealthnews.org/news/article/prior-authorization-insurance-delays-coverage-denials-state-laws-west-virginia/
4. HHS Secretary Kennedy, CMS Administrator Oz secure industry pledge to fix broken prior authorization system. News release. HHS. June 23, 2025. Accessed April 1, 2026. https://www.hhs.gov/press-room/kennedy-oz-cms-secure-healthcare-industry-pledge-to-fix-prior-authorization-system.html
5. States lead on prior authorization reform. ASCO in Action. June 16, 2025. Accessed April 1, 2026. https://www.asco.org/news-initiatives/policy-news-analysis/states-lead-prior-authorization-reform
6. COA Position Statement on Prior Authorization. COA. April 22, 2021. Accessed April 1, 2026. https://mycoa.communityoncology.org/publications/position-statements/coa-position-statement-prior-authorization
7. February 2026 Newsletter. Community Oncology Alliance. March 2, 2026. Accessed April 1, 2026. https://mycoa.communityoncology.org/news-updates/coa-newsletters/february-2026-newsletter