About the Current Prior
Authorization System
Prior authorization is a health plan requirement that your physician must seek approval from your health plan before you can access a service or prescription. Prior authorization is overused, costly, inefficient, opaque and causes patient care delays.
Prior Authorization's Impact
Prior Authorization's Impact
94%
of physicians
say prior authorization sometimes, often or always results in care delays for their patients.
24%
of physicians
report that prior authorization has led to a serious adverse event for a patient in their care.
95%
of physicians
report that prior authorization somewhat or significantly increases physician burnout.
Patient Impact
Prior authorization prevents you from receiving the timely care you need.
Even though your physician knows best, insurance companies or pharmacy benefit managers can delay the start of your care by taking their time deciding if it is “medically necessary.”
When time is wasted, your health suffers. Prior authorization can lead to treatment abandonment and even serious adverse events, including hospitalization, disability or even death. *
Prior authorization can prevent you from being able to use the benefits offered by your health plan that you already pay for through subsidies and premiums. Plus, if an insurer delays or denies your prior authorization, it can negatively impact your health and potentially lead you to taking more sick days, being less productive at work and missing out on your day-to-day life.
Physician Impact
Prior authorization comes between you and your patients’ care.
You know the best treatment route for your patients, yet prior authorization undermines your expertise by having the final say in if the treatment is “medically necessary.” The criteria are unclear every step of the way, and sometimes you don’t know when prescribing a treatment if it will require prior authorization or not.
Prior authorization costs you valuable time. Practices complete an average of 43 prior authorizations per physician, per week. This administrative nightmare eats up roughly one and a half business days (12 hours) weekly of physician and staff time. *
Prior authorization doesn't put your patients first. 94% percent of physicians say prior authorization sometimes, often or always results in care delays. * Then, your patients’ illnesses go untreated for longer because of an unclear, complicated process.
