Prior Authorization Hassles Almost Always Cause Care Delays, Survey Shows

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Most physicians know that health insurers’ prior authorization policies delay access to care, often causing serious harm to patients. A survey of physicians taken in December 2020 by the American Medical Association shows just how often prior auth delays occur.

According to the AMA survey, 94% of physicians reported delays while waiting for health plans to authorize necessary care, and 79% have had patients abandon treatment because of prior auth.

In addition, 70% of the 1,000 physicians surveyed said health insurers had reverted to pre-COVID-19 authorization policies or never relaxed these policies.

“As the COVID-19 pandemic began in early 2020, some commercial health insurers temporarily relaxed prior authorization requirements to reduce administrative burdens and support rapid patient access to needed drugs, tests and treatments,” AMA President Susan R. Bailey, MD, said in a statement. “By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care.”

The Texas Medical Association has continuously worked to ease the burden prior authorizations put on physicians and the harm it can cause to patients.

This week, TMA plans to testify on several bills before the House Insurance Committee, including a bill that would, in part, require utilization reviews to be conducted by physicians of the same or a similar specialty as the physician who requested approval for the treatment.

According to the AMA survey, only 15% of physicians reported health plans’ prior authorization criteria were often or always based on evidence-based medicine.

Other survey findings include:

  • 85% said burdens associated with prior authorization were high or extremely high,
  • 40% employ staff who  exclusively work on tasks associated with prior authorizations, and
  • 30% said prior authorizations led to a serious adverse event for a patient in their care. 

TMA needs your voice to help rein in these hassles, and has created a prior authorization social media toolkit that includes messages, sample posts, and articles you can share on your personal or practice social media channels.

Find the prior authorization social media toolkit in the Advocacy Toolkits section of the TMA website.

Last Updated On

April 12, 2021

Originally Published On

April 12, 2021

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