Fixing Prior Authorization
Prior authorization is an overused, costly, inefficient, and opaque process that comes between you and your patients. It’s time to make this system work better for everyone.
The Problem
Prior authorization was intended to control costs, but it’s become an obstacle to patient-centered care.
- 93% of physicians say prior authorization sometimes, often, or always results in care delays for their patients.
- 29% of physicians report that prior authorization has led to a serious adverse event for a patient in their care.
- 89% of physicians report that prior authorization somewhat or significantly increases physician burnout.
Physicians need a system that supports, not hinders, clinical decision-making.
Physician Stories: In Their Own Words
Every day, health care professionals throughout the country experience the negative effects of the flawed prior authorization process.
“[Prior authorization] takes me 8 weeks of work for what could have been squashed on day one if the system were not broken.”
Breana B., PA, Arizona
“The single most frustrating issue I have faced as a primary care physician, that constantly makes me second guess my dreams, is the prior authorization issue.”
Harrine R., MD, Maryland
“The insurance companies do not take the patient into account. They deny procedures even when their medical experts agree with your assessment.”
Vanny L., MD, New Jersey
The Path Forward
The AMA and a coalition of state and specialty societies developed 21 Prior Authorization and Utilization Management Reform Principles to guide meaningful change in the system. These principles promote transparency, clinical validity, and automation that actually reduces delays.