50 percent of physicians experienced a 20 percent rejection rate on first-time prior authorization requests for pharmaceutical treatments, and one-third experienced a 20 percent rejection rate for first-time prior authorization requests for diagnostics and procedures such as cardiac stress tests and nuclear imaging.
2. Prior authorization takes up physicians’ time, decreasing the time spent with patients and increasing health care costs. An American College of Cardiology study found that: 77 percent of doctors spent less time on patient care because they instead had to deal with medical documentation involved in the prior authorization process.
87 percent said they dealt with prior authorization issues on at least a weekly basis,. 3. For patients with serious problems such as cardiovascular issues, the delay – or complete rejection – of treatment could mean death. “The insurance company will typically not even consider approving the medication if the patient hasn’t experienced (a heart) event,” Shor said. In other words, they can’t get the treatment prescribed by their doctor to prevent a heart attack because they haven’t already had one. If they fail to get their preventive treatment and have a heart event, they could die. Concerns that aggressive prior authorization programs place cost savings ahead of optimal care have led a coalition to call for changes in the health insurance industry. Representing hospitals, medical groups, patients, pharmacists and physicians, the group has proposed 21 principles for improvements to prior authorization programs. “Strict or bureaucratic oversight programs for drug or medical treatments have delayed access to necessary care, wasted limited health care resources and antagonized patients and physicians alike,” American Medical Association President Andrew W. Gurman said in an official statement. “The AMA joins the other coalition organizations in urging health insurers and others to apply the reform principles and streamline requirements, lengthy assessments and inconsistent rules in current prior authorization programs.” Read more by clicking here.