Review Shows Prior Authorizations Lead to Poor Patient Outcomes, Provider Burnout

Findings from a newly published analysis confirm a belief held by many pharmacists: Prior authorizations (PAs) lead to access issues that affect patient care.¹ PAs involve completing paperwork before a payer approves the prescribed therapy. The plan flags the medication as requiring authorization, and someone (usually the clinician or their staff) must provide clinical information explaining the medical necessity or the need for the therapy over potentially cheaper options.

A scoping review published in JAMA Neurology examined the effects of PA policies on patients with neurologic conditions. The investigators reviewed studies on the consequences of PAs for patients and clinicians.

The disease states included in the initial data search were Alzheimer disease, Parkinson disease, multiple sclerosis, migraine, cerebrovascular disease, and epilepsy. A total of 278 studies were screened, and 20 met the eligibility criteria.¹

The investigators noted that the rationale for PAs was to reduce spending and medical waste, and data from the National Bureau of Economic Research (NBER) supported this rationale. Data from the NBER study showed that among Medicare Part D patients, PAs reduced the use of restricted drugs by 26.8% and effectively reduced drug spending by $96 per beneficiary-year, without a significant impact on outcomes.²

However, findings from the scoping review published in JAMA Neurology indicate that PAs led to delays in therapy, affecting outcomes, and increased administrative burdens, which increased provider burnout. The review found that the most frequently identified consequences of PAs were delays in care (60%) and increased disease activity (25%). In one study, for example, roughly half of patients with multiple sclerosis awaiting approval for disease-modifying therapies experienced relapses.¹

The most identified consequence for clinicians and administrators was the time burden. Findings from a 2024 survey by the American Medical Association revealed that 89% of physicians reported increases in burnout due to PAs, with 20% always appealing a PA rejection.³ They estimated spending 13 hours per week on completing PAs. Twenty-nine percent of physicians reported that a PA has led to serious adverse patient health outcomes. The scoping review identified provider burnout as a topic discussed in 2 neurology studies.

One potential solution to relieve the burden of PAs is to enlist clinical pharmacists, technicians, and health system specialty pharmacies to help complete PA paperwork. The investigators also inferred a role for managed care pharmacists in ensuring insurance company policies and guidelines are based on the most recent medical evidence.¹

The investigators concluded that urgent reform of the PA process is needed to ensure patients receive clinically necessary medications in a prompt and equitable manner.

REFERENCES

1. Gotlieb E, Joseph B, Blank L, Jetté N. Barriers and consequences of prior authorization for neurologic medications: a scoping review. JAMA Neurol. 2026;83(2):181-192. doi:10.1001/jamaneurol.2025.4560

2. Brot-Goldberg ZC, Burn S, Layton T, Vabson B. Rationing medicine through bureaucracy: authorization restrictions in Medicare. National Bureau of Economic Research working paper 30878. January 2023. doi:10.3386/w30878 https://www.nber.org/papers/w30878

3. 2024 AMA prior authorization physician survey. American Medical Association. Accessed March 1, 2026. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf