Prior authorization leads to delays in care

Prior authorization that requires physicians to get approval from health insurers for certain drugs, tests and treatments isn’t good for patients, according to a survey of 1,000 practicing physicians from the American Medical Association (AMA).

Specifically, the requirements have led to serious or life-threatening events for patients and a distressing impact on physicians. More than 9 in 10 physicians surveyed said prior authorization (PA) programs have a negative impact on patient clinical outcomes.

For most, prior authorization can lead to delays in necessary care and even patients abandoning their treatment plan. The process also takes its toll on physician practices. On average, practices complete 31 PAs per physician per week, and more than one-third of physicians have staff who work exclusively on PA. The requirements have previously been cited among healthcare organizations as a top regulatory burden.

“The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care,” AMA Chair Jack Resneck, Jr., MD, said in a statement.

On average, most physicians and staff had to wait at least one business day for a PA decision (65 percent), while 26 percent reported waiting at least three business days. The overwhelming majority of physicians––91 percent––reported care delays for patients whose treatment required PA. Seventy-five percent of respondents said the PA process can lead to treatment abandonment.

The PA process is an extremely high or high burden for 86 percent of physician practices, the survey found. That burden is also getting worse; 88 percent reported PA burdens worsening over the last five years.

Prior authorization has been used as a reform method to help control healthcare costs and ensure patients are getting necessary care that will work. However, the execution of these requirements has led to several problems for providers. Associations like the AMA have advocated for fixes within PA programs to streamline the process.

“The time is now for insurance companies to work with physicians, not against us, to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality healthcare they need," Resneck said.