AMA Survey: Prior Authorization Negatively Impacts Patient Outcomes

More than nine in 10 physicians say health plan prior authorization requirements have a negative impact on patient clinical outcomes, according to a survey released today by the American Medical Association. Almost two-thirds of the 1,000 physicians surveyed reported waiting at least one business day for prior authorization decisions from health plans. Respondents reported spending nearly 15 hours to process an average 29 prior authorizations per week, and 86% said the burden had increased in the past five years. "Under prior authorization programs, health insurance companies make it harder to prescribe an increasing number of medications or medical services until the treating doctor has submitted documentation justifying the recommended treatment,” said AMA Chair-elect Jack Resneck Jr., M.D. “In practice, insurers eventually authorize most requests, but the process can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to vital care.” In January, six organizations representing health plans and health care providers, including the AHA and AMA, agreed to collaborate to improve the prior authorization process.