Survey Indicates Prior Authorization Wreaks Havoc on Patient Care

The American Medical Association (AMA) has recently released a survey that reveals the significant disruption in patient care caused by prior authorization. The burdensome process leads to care delays, serious adverse events, and even patient abandonment of necessary treatments.

Prior authorization is a health plan cost-control process that requires healthcare professionals to obtain advance approval from the health plan before a prescription medication or medical service qualifies for payment and can be delivered to the patient. While health plans and benefit managers contend that prior authorization programs are necessary to control costs, physicians and other providers find these programs to be time-consuming barriers to the delivery of necessary treatment.

According to the survey, which examined the experiences of 1,000 patient care physicians, nearly two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers—and nearly a third (30 percent) said they wait three business days or longer. The survey found that 94% of doctors say prior authorization leads to delays in patient care. One in three doctors (33%) say prior authorization has led to serious adverse events with their patients.

Effects on Treatment Abandonment

The 2022 AMA survey found that for patients whose treatment required prior authorization, 94% of physician respondents said the process led to delays in care for patients. 80% reported that delays due to prior authorization resulted in patients abandoning their recommended course of treatment either sometimes or more often.

The AMA believes there is a need for prior authorization reform. The payer cost-control process of prior authorization wastes physicians’ time and delays patient care. The AMA is fighting for greater insurer accountability and transparency for prior authorization requirements.

In conclusion, the AMA survey reveals the significant disruption in patient care caused by prior authorization. The burdensome process leads to care delays, serious adverse events, and even patient abandonment of necessary treatments. There is a clear need for reform in the prior authorization process to ensure the delivery of necessary patient care.