Prior Authorizations: A Barrier to Patient Care

One topic that I think is a major problem in current healthcare is prior authorizations. Prior authorizations happen when an insurance company has to review & approve a medication or treatment before they agree to cover it. Prior auths are supposed to lower costs and make sure patients are receiving the correct treatments. However, we see long delays with prescription coverage, which creates stress for patients. 


The main reason it is such a big issue is that patients often don’t know their medication needs a prior auth until they go to pick it up and are expecting treatment. A doctor will prescribe a medication, the prescription gets sent to the pharmacy, and then the patient finds out their insurance will not cover it until a prior authorization is approved. Instead of being able to pick up their medication at the pharmacy right away, the patient will be forced to wait an unknown amount of time before the prior auth is reviewed and approved. These delays can be serious for urgent medications because they can last multiple days to even weeks. Even a short delay in getting medication can lead to worsening symptoms, poor disease control, and ultimately end in hospital visits. 


This issue also affects healthcare workers, as they must spend extra time and resources dealing with insurance companies instead of focusing on patient care. There is also a lack of clear communication between healthcare workers who are involved with the prior authorization. After the pharmacy sends it to the doctor, the pharmacy cannot provide the patient with any information. We often tell patients at my pharmacy that they will have to contact their doctor for updated information regarding the approval. The pharmacy also does not get notified quickly when the medication is approved, so the prescription can sit in the queue even longer than it needs to after approval.


I can understand the reasoning for using prior authorizations to cut costs and prevent unnecessary spending and treatments. However, the current system is too complicated and slow, especially when many of these medications are commonly prescribed and appropriate. The healthcare system should be making it easier for people to access medications and treatments, not harder. 



https://www.ama-assn.org/system/files/prior-authorization-survey.pdf

https://pmc.ncbi.nlm.nih.gov/articles/PMC10332446/

https://pmc.ncbi.nlm.nih.gov/articles/PMC11425057/

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