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). Among the 91% of surveyed physicians who treat patients between the ages of 18 and 65 and currently in the workforce, more than half (58%) report that PA has interfered with a patient's ability to perform his or her job responsibilities. At the end of the day, PA isn’t “cheap” when it interferes with maintaining a healthy, productive workforce.

The care delays, abandonment, and denials related to PA can lead to significant negative clinical outcomes for your employees. In fact, one-third (33%) of physicians report that PA has led to a serious adverse event, such as hospitalization, disability, or even death, for a patient in their care.* If your employee ends up in the hospital, PA ends up hurting your bottom line—and more importantly, the health of your workforce.

You do your best to provide employees with an affordable benefit package that ensures access to medically necessary care. But PA can prevent your employees from being able to use the benefits already paid for via subsidies and premiums. What is the value of health care benefits if your employees can’t receive timely care—or are forced to pay for treatments out of pocket?

Health plans agreed to make changes to improve the PA process several years ago, but surveyed physicians report sluggish progress on these reforms.* Now is the time for employers to demand transparency from health plans on the growing impact of PA programs on the health of their workforce.