HCN News & Notes

AMA Physician Survey Raises Concerns About Prior Authorization

CHICAGO — According to a new physician survey released by the American Medical Assoc. (AMA), more than nine in ten physicians (92{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) say prior-authorization programs have a negative impact on patient clinical outcomes.

Prior authorization programs are barriers to care, causing wait times that are especially detrimental to those suffering from substance-use disorder, as nearly two-thirds of drug plans require prior authorization for addiction treatment. Nationwide, nearly 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those needing treatment for illicit drug use are not receiving it.

The AMA believes that policymakers must push insurers to remove barriers to care, including prior authorization for medication-assisted treatment (MAT) and non-opioid treatments for pain management. MAT is widely recognized as an effective, evidence-based treatment option for opioid addiction because it effectively removes the physical need to use opioids and has even been shown to reduce the illegal use of opioids markedly.

Examining the experiences of 1,000 patient-care physicians, the survey found that 94{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians reported waiting at least one business day for prior-authorization decisions from insurers. Furthermore, nearly four in five physicians (78{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) reported that prior authorization can sometimes, often, or always lead to patients abandoning a recommended course of treatment, which can lead to negative consequences for those suffering from substance use disorder.

“The AMA survey illustrates a critical need to help patients have access to safe, timely, and affordable care, while reducing administrative burdens that take resources away from patient care,” said AMA Chair-elect Dr. Jack Resneck Jr. “In response, the AMA has taken a leading role in convening organizations representing pharmacists, medical groups, hospitals, and health insurers to take positive, collaborative steps aimed at improving prior-authorization processes for patients’ medical treatments.”