REFORM
PRIOR AUTH!
Put Kentucky Patients First & Reduce Barriers to Care
What is Prior Authorization?
Prior authorization is a complicated, time-consuming, administrative process requiring physicians to obtain advance approval for medical care from a health plan before a specific service or medication is delivered.
Prior Auth Interferes with Patient Care, While Adding to Physicians’ Administrative Burden
The overuse and misuse of prior authorizations negatively impacts patients and providers and leads to:
Care delays for patients
Administrative burdens for physicians
Increased costs to the healthcare system
Prior Auth
by the Numbers
Researchers estimate waste, including administrative costs like prior authorization, amounts to $245 billion, or $2,497 per person, per year.
A 2021 American Medical Association survey of more than 1,000 practicing physicians from across the country revealed that more than 40% have staff who work exclusively on prior auth, and that on average, process 41 prior authorizations, per physician, per week.
Each required prior authorization costs physicians between $10.92 and $14 to obtain.
KMA Physicians Agree:
Prior Auth is a Problematic Barrier to Care
82% of physicians said that issues related to the prior auth process lead to patients’ delays or changes to patients’ recommended course of treatment.
81% of physicians said the prior auth process delays access to necessary care for patients.
Over half of physicians said that the burden associated with prior auths is extremely high or high.
7 in 10 physicians said that the amount of work associated with the prior auth process has increased in recent years.
