Prior authorization (PA) is utilized by 96% of health plans, and payers show little appetite for relaxing renewal requirements even for stable, lifelong therapies.1 For large health systems and specialty pharmacy hubs, that volume is manageable. The American Medical Association (AMA) reports that 40% of larger physician practices employ staff who work exclusively on prior authorizations.2 But independent pharmacies rarely have that luxury. One pharmacist often manages a full dispensing queue, patient counseling, point-of-care testing, and a specialty PA denial at the same time, with no dedicated coordinator and no payer-specific template on hand.
The Scale of the Burden
The AMA's 2025 Prior Authorization Physician Survey, released in May 2026, found that 95% of physicians say PA delays access to necessary care, and 79% report that patients abandon treatment because of PA friction.3 Physicians complete an average of 39 prior authorizations per week and spend 13 hours on the process, an estimated $34,000 and 700 hours of administrative cost annually per physician.3
That burden does not stay with the prescriber. When a PA is incomplete or missing the right documentation, the rejection lands at the pharmacy counter, not the prescriber's desk. The pharmacist fields the patient's call, coordinates back with the office, and often becomes the de facto translator between payer policy and a clinical team that may not know what that specific payer requires. Sixty percent of practices need at least 3 employees to complete a single PA request, and 35% spend over 35 minutes per request.2 For an independent pharmacy operating on compressed margins, that labor cost is real even when it never appears on a balance sheet.
Specialty Drugs Carry the Heaviest Load
Specialty medications carry the most complex, most payer-specific documentation standards, and they are projected to exceed 60% of pharmacy spend by 2026 despite accounting for fewer than 5% of prescriptions.1 Step therapy requirements, clinical exception pathways, site-of-care edits, and renewal timelines vary by payer, plan, and sometimes individual formulary tier.
A 2025 analysis at a large specialty cancer pharmacy found over 100 PA requests required per week, with 1 in 6 prescriptions ultimately denied and a maximum resolution time of 35 days for specialty drugs.4 That was at a well-resourced center with trained staff. The friction at an independent pharmacy serving a less-resourced population is not likely to be smaller.
Why the Information Gap Is the Real Problem
Utilization management, applied appropriately, serves a legitimate clinical and financial function. The friction is not that PA exists. It is that payers define their criteria internally and communicate them outward imperfectly, so prescribers and pharmacists usually learn what was required only after a rejection tells them what was missing.
