Prior Authorization Reform Strategies

Insurance prior authorizations for certain drugs, tests and treatments continue to burden medical practices and could negatively affect patient outcomes, according to new survey results from the American Medical Association.

The survey took place in December among 1,000 practicing physicians.

Seven findings:

1. Ninety-one percent of respondents reported care delays associated with prior authorizations.

2. Sixty-five percent of respondents reported waiting at least once business day, on average, for a prior authorization decision from health plans. Twenty-six reported waiting three business days or more.

3. Twenty-eight percent of respondents reported that the prior authorizations affected care delivery and led to a serious adverse event (death, hospitalization, disability/permanent bodily damage, or other life-threatening event) for a patient.

4. Seventy-five percent of respondents reported that issues related to prior authorizations can result in patients abandoning their recommended treatment.

5. Most respondents (91 percent) said prior authorizations have a significant or negative impact on patient clinical outcomes.

6. Eighty-six percent of respondents said burdens associated with prior authorization were high or extremely high, and 88 percent said they believe these burdens have climbed in the last five years.

7. On average, a medical practice completes 31 prior authorization requirements per physician, per week.

Read more about the survey here.