AMA Survey: Prior Authorization Leads to Serious Adverse Health Outcomes

One in three physician respondents to a survey conducted by the American Medical Association (AMA) said prior authorization has led to serious or life-threatening events for their patients.

The AMA conducted the survey in December 2018, asking 1,000 practicing physicians (40% primary care physicians, 60% other specialists) questions focused on the volume of, time to complete, and resources they have for addressing prior authorizations.

Traditionally used by health plans to determine the necessity of newer, expensive drugs, tests and treatments, prior authorization is much more widespread today than in years past and now often required for medications and services that are not new or costly. This is confirmed by the AMA survey, with 88% of respondents reporting the volume of prior authorizations has increased over the past five years.  

Other highlights of the survey:

  • 91% of respondents reported delays in care due to the prior authorization process
  • 75% said PA often causes patients to abandon their recommended course of treatment
  • 86% feel the burden association with PA is high or extremely high
  • 36% of physicians have staff who work exclusively with prior authorizations
  • On average, practices process 31 prior authorizations per physician per week, taking up the equivalent of two business days—time that could be spent caring for patients

“The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care,” AMA Chair Jack Resneck, Jr., MD said in a press release. “The time is now for insurance companies to work with physicians, not against us, to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality health care they need.”

To protect patient health, reducing the prior authorization burden is among MAFP’s advocacy priorities for 2019 and will be a topic of discussion with state legislators during the sold out Michigan Family Medicine Advocacy Day on February 26 in Lansing.