Health plans tout prior authorization (PA) as a cost-saving measure to employers, but they may not be disclosing the full consequences of PA on your bottom line or your employees’ well-being.
When an employee needs medical care, they turn to their physician. Unfortunately, PA requirements force physicians to contact the health plan or pharmacy benefit manager to get approval for certain treatments before they can administer care. Your employees can wait days, weeks, or even months for approval;* worse still, they may not receive any care if they abandon treatment or the insurer denies the PA. Result? Your employees’ health suffers, potentially leading them to take sick days (absenteeism) or be less productive at work (presenteeism). At the end of the day, PA isn’t “cheap” when it interferes with maintaining a healthy, productive workforce.