Prior Authorization Burdens Effect Quality Of Patient Care

The burdensome process of prior authorization reduces the time physicians have to take care of their patients.

As an active practicing physician and a past president of the Harris County Medical Society, I know the hassles of prior authorization.

Ninety-four percent of doctors reported care delays while waiting for health insurers to authorize necessary care. Nearly 80 percent of physicians say patients abandon treatment due to authorization struggles with health insurers.

Thirty percent of physicians report the prior authorization process required by health insurers for certain drugs, tests, and treatments has led to a serious adverse event, such as: death, hospitalization, or disability for a patient in their care.

On average, practices complete 40 prior authorizations per physician, per week, which can consume an average of nearly two business days of physician and staff time.

These results from the AMA’s survey conducted at the height of the COVID-19 pandemic in December 2020 highlight the significant negative impact of prior authorization on patients and physicians. The findings illustrate a critical need to streamline or eliminate low-value prior-authorization requirements to minimize delays or disruptions in care delivery.

The AMA has taken a leading role in advocating for prior authorization reforms and convening key industry stakeholders to develop a roadmap for improving the prior authorization process.

The AMA has developed model state legislation and resources to support and drive prior authorization and step therapy reforms. In 2019, there were more than 80 bills in state legislatures addressing utilization management, and in 17 states, medical societies were able to enact prior authorization or step therapy legislation despite facing strong opposition from insurers and their local trade associations. There are numerous bills under consideration this year. Texas was able to convince its legislature to enact a “gold card” for doctors who don’t order unnecessary tests who then get a pass on prior authorization.

For several years, the AMA has conducted a multi-faceted campaign urging health plans to “right-size” prior authorization programs. Due to successful AMA advocacy, CMS is addressing prior authorization burdens through the “Patients Over Paperwork” Initiative.


But, we can’t let up.  Prior authorization burdens are a major issue for patients and physicians. As physicians we need to continue to advocate for ourselves and for our patients. Physicians can get involved in the AMA grassroots advocacy campaign —   And physicians need to continue to raise their voices through their local, state and national government representatives.

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