Prior authorization can often be a major hassle for physicians, administrators and patients trying to get needed medical procedures or prescriptions.
Dermatologist and past president of the American Medical Association, Jack Resneck Jr., MD, told the AMA some key things physicians wish patients knew about prior authorization in a Sept. 11 report.
1. Insurance companies want to spend less. Insurers make physicians jump through several hoops to get patients access to certain medications, with the insurers' end goal being spending less to cover certain treatments and therapies.
2. It complicates the decision-making process. It complicates the decision process for both patients and physicians, because physicians have to determine what treatments patients will actually have access to.
3. Prior authorization is a guessing game. It can be a guessing game what information insurers need for prior authorization requests. Sometimes, the people reviewing the requests have no medical background and don't know what information provided by the physician means.
4. Fighting rejections is time-consuming. Physicians spend a large amount of time fighting prior authorization denials in an effort to get patients what they need.
5. Barriers are causing harm. Health plans are making it hard for patients to receive care they need by imposing prior authorization barriers.
6. Prior authorization is unpredictable. Even physicians don't know where the rules are headed.
7. Services once covered might change. For some medications, patients could be receiving successful treatment for a year and then be subject to prior authorizations.
8. Physicians are just as frustrated. Physicians are frustrated in the name of patients and are often just as frustrated that they have to keep fighting for patient rights.
9. There are ongoing efforts to fix prior authorization. The AMA is routinely working with Congress and legislatures to advance bills to fix and repeal prior authorization. Patients can help by reaching out to Congress members and letting them know prior authorization is a top priority.