Prior authorization requirements over the past half-decade have increased and an overwhelming number of physicians say that the practice of seeking them interferes with continuity of care. In fact, more than 85 percent of the physicians asked said the practice impacts them, according to a new survey from the American Medical Association.
The survey connected with 1,000 physicians, which found that more than “two-thirds said it's difficult for them to determine whether a prescription or service needs prior authorization.” Contrarily, fewer than 10 percent of the physicians interviewed said they contract with a health plan that allows programs that can exempt providers from the requirement.
Separately, a 2017 MGMA survey showed similar results, with 86 percent of providers reporting an increase in prior authorization requirements that year, and a separate survey from the AMA found 90 percent of providers agreed that prior authorizations delay care.
However, despite these figures and the growing concern by physicians, payers have yet to widely implement reforms. The survey found that the majority of physicians in the survey (88 and 86 percent, respectively) report that the number of prior authorizations required for prescription drugs and medical services increased over the last five years.
This second survey found health payers have stalled their progress with implementing the other prior authorization reforms, too. Additionally, 8 percent of physicians reported contracting with health plans that offer selective application of prior authorization requirements or prior authorization requirement exemptions based on the provider’s performance and adherence to evidence-based medicine.
Sixty-nine percent of physicians still find it difficult to determine whether a prescription or service requires prior authorization; 85 percent of physicians say prior authorizations still interfere with continuity of care; the majority of physicians agree phone and fax are still the primary method for completing prior authorizations. Only 21 percent report their EHR systems offer electronic prior authorizations for prescription drugs.
Based on this feedback, prior authorizations are a stumbling block at the point of care, physicians say.
Per the AMA report mentioned at the top, most prior authorizations are obtained by phone or fax. Only about 20 percent of physicians said their EHRs allowed for electronic approvals, which can be more efficient.
AMA and groups like the American Academy of Family Physicians continue to argue that payers need to improve the prior authorization process. In a statement released with the survey findings, AMA said insurance companies have a "year of foot-dragging and opposition" to prior authorization reforms.
However, payers view prior authorizations as a vital cost control that limits unnecessary care. Prior authorizations also have their supporters in Washington. A Government Accountability Office report released in 2017 found that prior authorization in Medicare saved as much as $1.9 billion through March 2017. The Trump administration's proposed budget also includes expanded prior authorization measures for Medicare.
America's Health Insurance Plans and the Blue Cross Blue Shield Association joined the AMA, American Hospital Association, American Pharmacists Association and Medical Group Management Association, releasing a "Consensus Statement on Improving the Prior Authorization Process" last year.
