Prior authorization is a health plan cost control process by which physicians and other health care providers must qualify for payment coverage by obtaining advance approval from a health plan before a specific service is delivered to the patient.
The AMA believes prior authorization is overused and existing processes present significant administrative and clinical concerns. In order to reduce the harmful impact of these utilization management programs, the AMA has conducted significant research designed to reveal physician concerns over patient care delays, administrative costs and workflow disruptions caused by prior authorization.
Prior authorization physician survey
A recent survey of 1,000 practicing physicians (PDF)—who routinely complete prior authorizations in their practice—showed the significant burden prior authorization policies can have on physician practices and patients.
Analysis of progress on prior authorization reform
The 2018 AMA Prior Authorization Physician Survey also revealed that health plans have not widely implemented necessary reforms (PDF) to help improve the prior authorization process, despite agreements made by health plan associations in the Consensus Statement on Improving the Prior Authorization Process.
Study shows prior authorization burden
A qualitative study exploring the fundamental sources of physician satisfaction and dissatisfaction (PDF)—and the effects of administrative work on practices—includes first-hand physician perspectives on how prior authorization impacts physician practices and delivery of care to patients.