How physicians feel about prior authorizations

According to the survey, 94% of physicians reported that prior authorization always, often, or sometimes leads to delays in necessary care.

The survey also found that 78% of physicians said that prior authorization can sometimes or often lead to patients abandoning their recommended course of treatment.

In addition, 24% of physicians said that prior authorization led to a serious adverse event for a patient in their care, including:

• 19% of physicians who said a prior authorization led to a patient's hospitalization
• 13% of physicians who said a prior authorization led to a life-threatening event or required intervention to prevent permanent impairment or damage
• 7% of physicians who said a prior authorization led to a patient's disability/permanent bodily damage, congenital anomaly/birth defect, or death

Overall, 35% of physicians in the survey said that prior authorization criteria are rarely or never evidence-based, and 93% of physicians said that prior authorization has had a somewhat or significant negative impact on clinical outcomes.

The survey also found that prior authorization has a significant impact on physicians themselves. On average, the survey found that practices complete 43 prior authorizations per physician per week, and that physicians and staff spend 12 hours each week completing prior authorizations.

As a result, 95% of physicians in the survey said that prior authorization somewhat or significantly increases burnout.

Prior authorization also adds "significant costs to the entire health care system," according to AMA. The survey found that 87% of physicians reported that prior authorization always, often, or sometimes leads to higher overall utilization.

The survey also found that 79% of physicians reported that the prior authorization process at least sometimes leads patients to pay out of pocket for a medication.

(American Medical Association press release, 6/18; 2023 AMA prior authorization physician survey, accessed 6/26)

Learn how BCBS of South Carolina created a live prior-authorization tracker to increase transparency and reduce member frustration.