Physician survey illuminates negative impact of prior authorization

Editor's Note

The American Medical Association (AMA) annual, nationwide prior authorization survey reveals that over 90% of physicians believe prior authorization negatively impacts patient clinical outcomes. “More telling,” AMA reported July 17, is the fact that 78% of physicians report that this process “sometimes or often” leads to patients abandoning recommended treatments.

Prior authorization, an insurance requirement for pre-approval of medical services, frequently causes care delays and serious adverse events. Examples cited by the 1,000 surveyed physicians include the following:  

• delayed access to necessary care, cited by 94% of respondents
• serious adverse events leading to hospitalization, cited by 19% of respondents
• serious adverse events leading to life-threatening events or intervention to prevent permanent impairment or damage, cited by 13% of respondents
• serious adverse events leading to disability, permanent bodily damage, congenital anomalies, birth defects, or death, cited by 7 % of respondents

Additionally, more than half of physicians with patients in the workforce said prior authorization affected patients’ job performance.

Respondents also detailed the burden prior authorization places on physicians, noting that they rarely speak to an appropriate peer and must complete an average of prior authorizations per week, amounting to 12 hours of work for their practices. The survey also sheds light on how prior authorization adds costs to the entire health system. For example:

• 87% said that prior authorization leads to higher overall health care utilization
• 79% said prior authorization led to patients paying out of their own pocket for a medication
• 69% reported ineffective initial treatments; for example, due to step-therapy requirements
• 68% said prior authorization led to additional office visits
• 42% reported immediate care or emergency department visits
• 29% reported hospitalizations