Prior Authorization: Impact on Medical Practices

prior authorization

Prior authorization: the dreaded back-and-forth process, adding hours (maybe even days) to fill a simple prescription. It's a process. For physicians and staff, it's a frustrating stream of asynchronous communicating with billers, pharmacists, health insurance companies, you name it. 

The burden of prior authorizations has only increased in recent years (especially in the US) for the pharmacists and physicians. 

The State of Prior Authorization

A study conducted in 2016 by JumpRX found some interesting insights regarding the impact of prior authorization on medical practices. 

Across the 500 physicians surveyed, the average physician (for all specialties) completed 35 prior authorizations per week. 

A Lot of Doctors Are Doing Prior Authorizations 

This study also found that one out of every five physicians in the US complete 50 or more prior authorizations weekly.  About one-third of physicians complete 20 to 49 prior authorizations weekly.

prior authorization 2017

 

There's Zero Transparency

We don't even know when they're coming. The same study found that sixty-three percent of all US physicians report that they are “not sure” if a desired prescription they are going to prescribe for a patient will require a prior authorization at the time they decide to prescribe the medication. 

Over half of physicians don't know whether or not the prescription they write will actually need a prior-authorization or not. This is a problem.

Significant Burden

Over half of physicians report that prior authorization is an “immense” or “significant” burden to their practice today. See below for the breakdown. Only 1% of physicians surveyed said that the burden was "none." What are we doing about it?

prior authorization

Fixing the Prior Authorization Game

We can't just get rid of prior authorizations, as they are connected to a series of regulations and processes that make up the healthcare industry (at least for now). What we can do, however, is to provide more efficient means of getting prior authorizations done.

We can encourage methods that boost operational efficiency: saving medical practices, pharmacies, billers, insurers (and patients) time and money.

The study found that a whopping 83% of physicians surveyed are interested in accessing prior authorization guidelines online (requirements for approval), and 67% were interested in accessing prior authorization information through web browser.

We're getting somewhere.

Digitizing Prior Authorizations

Moving prior authorization activity to digital, cloud-based messaging (accessible from web and app) will create a more efficient prior authorization channel. With synchronous messaging platforms that reduce phone tag, communication within the medical field can be one less thing for physicians to worry about.