Prior authorization increases use of health care resources, physicians say

Editor’s Note: In the era of specialty launches and increased payer utilization management requirements, life sciences brands need to be strategic to overcome prior authorization hurdles if they wish to unlock patient access to drive brand growth. Commercial leaders understand that utilization management requirements like PAs can be disruptive in the prescription access journey - often resulting in prescription abandonment and misaligned incentives that can impact brand growth. Despite this reality, most brands have been unsuccessful in creating actionable, real-time feedback loops on the prior authorization process that allows them to respond to the dynamic challenges facing their brands. To maximize success in today’s environment, it’s critical for brands to have end to end visibility into the prior authorization process and equip their field teams with actionable data that can be leveraged to improve UM outcomes. The PhilRx Patient Access Platform is designed to optimize brand gross to net with unique capabilities inclusive of a software driven PA process that creates visibility for brand teams to act on how payers are treating their products. To learn more about how we rapidly improve coverage outcomes for brands facing patient access challenges, check out this case study detailing how we rapidly improved outcomes for Duchensay USA’s women’s health product Bonjesta TM.

Almost two-thirds of physicians report that prior authorization results in increased utilization of health care resources (e.g., additional office visits and initial use of less effective therapy due to step therapy requirements), according to survey results released by the American Medical Association (AMA).

A total of 1,001 practicing physicians responded to the survey. One-third of physicians reported that prior authorization led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death, while the majority (89 percent) reported that prior authorization had a negative impact on patient clinical outcomes.

Furthermore, most physicians reported that prior authorization delayed access to necessary care and 80 percent said patients abandoned treatment due to authorization struggles with health insurers. Nearly nine in 10 physicians (88 percent) said burdens associated with prior authorization were high or extremely high, with medical practices completing an average of 45 prior authorizations per physician, per week—consuming the equivalent of almost two business days (14 hours) of physician and staff time. More than one-third of physicians (35 percent) employ staff members to work exclusively on tasks associated with prior authorization.

"Health plans continue to inappropriately impose bureaucratic prior authorization policies that conflict with evidence-based clinical practices, waste vital resources, jeopardize quality care, and harm patients," Jack Resneck Jr., M.D., president of the AMA, said in a statement. "The byzantine system of authorization controls is rife with opportunities for reform and the AMA continues to work with federal and state officials on legislative solutions to reduce waste, improve efficiency, and protect patients from obstacles to medically necessary care."

More information: Survey

Citation: Prior authorization increases use of health care resources, physicians say (2023, March 16) retrieved 16 March 2023 from https:// medicalxpress.com/news/2023-03-prior-authorization-health-resources physicians.html

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