Prior Authorization Burdens Doctors and May Harm Patients

An American Medical Association (AMA) survey of 1,000 practicing physicians found that doctors believe that the prior authorizations required by insurance companies for some medications affect clinical outcomes for 90 percent of patients.

Patients are notified if a prior authorization is required when they attempt to fill their prescriptions. The survey found that nearly two-thirds of patients experienced a delay of at least one business day, while the rest waited at least three business days. Delays can sometimes cause many patients (80 percent, according to the survey) to abandon their prescribed course of treatment.

Jack Resneck Jr., MD, chair-elect of the AMA, told HealthDay, “There was a time when I expected a prior authorization request for some things I was ordering, like for very expensive or unusual medications. But the request for prior authorizations has grown exponentially, and a fair number I write now are for generic medications that never required a prior authorization in the past.”

The AMA and others are working with the association America’s Health Insurance Plans to improve the prior authorization process. Some of the ideas medical groups and insurers agree on include:

  • Reducing the amount of prior authorizations required for physicians who practice evidence-based medicine or participate in a value-based agreement with the insurer
  • Eliminating prior authorizations for medications that no longer need it
  • Protecting patient continuity of care during changes in coverage or insurance providers
  • Accelerating adoption of electronic standards and increasing insurer transparency

Source: HealthDay News, March 19, 2018.

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