Physicians: Prior Authorization Impedes Patient Outcomes

For many costly specialty drugs, payers implement cost-controlling strategies to ensure that patients wouldn’t be better suited for treatment with less expensive drugs. One such strategy, prior authorization (PA), has been criticized by providers as a hindrance to patient care.

Despite PAs largely becoming electronic to reduce wait times, in a recent survey conducted by the American Medical Association (AMA), 92% of physicians said that PA has a negative impact on patient outcomes.

These results add to a growing body of evidence that health care providers from all sectors feel that the PA process should be reformed, according to a press release from the AMA.

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“Under prior authorization programs, health insurance companies make it harder to prescribe an increasing number of medications or medical services until the treating doctor has submitted documentation justifying the recommended treatment,” AMA chair-elect Jack Resneck Jr, MD, said in the release. “In practice, insurers eventually authorize most requests, but the process can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to vital care. In my own practice, insurers are now requiring prior authorization even for generic medications, which has exponentially increased the daily paperwork burden.”

Included in the survey were 1000 patient care physicians who responded to various PA-related questions.

Approximately 64% of physicians said they waited at least 1 business day for a PA decision and 30% said they waited 3 or more business days, according to the AMA. During this time, patients are unable to start treatment.

Nearly all physicians also noted that wait times corresponded with delays in necessary care, which could up the risk of adverse events. Significantly, 78% of respondents said that PAs can result in patients forgoing necessary treatments, according to the release.

The survey found that 84% of responding physicians believe the burden of PAs is high or extremely high. Another 86% of physicians responded that the burden of PAs increased over the past 5 years.

The survey also revealed that each medical practice completes an average of 29.1 PAs per physician, each taking 14.6 hours to process, according to the release.

Physicians said they seek help from other staff members to ease the administrative burden of PAs, which takes these employees away from their duties, according to the survey.

“The AMA survey illustrates a critical need to help patients have access to safe, timely, and affordable care, while reducing administrative burdens that take resources away from patient care,” Dr Resneck said. “In response, the AMA has taken a leading role in convening organizations representing, pharmacists, medical groups, hospitals, and health insurers to take positive collaborative steps aimed at improving prior authorization processes for patients’ medical treatments.”