Important Issues

As much changed in 2020, one thing stayed the same - the burden of prior authorization on medical practices.

On April 7, the American Medical Association released survey results showing that for the overwhelming majority of physicians nationwide, prior authorization requirements imposed by commercial payers did not change during the pandemic. Of those, 30% of physicians reported that prior auth requirements led to a serious adverse event for a patient in their care.

You can see the press release and survey topline data here.

“As the COVID-19 pandemic began in early 2020, some commercial health insurers temporarily relaxed prior authorization requirements to reduce administrative burdens and support rapid patient access to needed drugs, tests and treatments,” said AMA President Susan R. Bailey, M.D. “By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care.”

The burden of the prior auth requirements include more than delaying patient care. Of those physicians surveyed, 40% said they employ staff members who work exclusively on prior auth tasks. The average physician practice spends 40 hours a week on prior authorization. Almost every physician surveyed (85%) said the burdens associated with prior authorization were high or extremely high.

MSDC continues to work at the local level in reducing the burden of prior authorization. Get involved through our advocacy website and sign-up.