Home  |  Core Issues  |  Prior Authorization

Prior Authorization

For patients with chronic health conditions, access to treatments and medications can be one of their most important health management tools. Insurers will try to find the cheapest medication option, even if it is not the one the patient was prescribed. Prior Authorization is a process often used by insurers and Pharmacy Benefit Managers to manage the approval of medications by requiring the use of other medications before accessing the prescribed medication.

 

The approval process can take weeks. Even after weeks, some patients are denied access to the medications they need on the basis that there is a cheaper medication offered. Physicians may have to grapple with insurance companies or the PBM to get the medication approved for their patients. While some of these cheaper options can work well, in some cases, medication can and is prescribed based on the individual patient’s needs. This process of prior authorization routinely interferes in the patient’s health by increasing the time and effort required to get the correct treatment or medication.  This process can also increase health care cost as it can leave the patient sicker for longer, sometimes requiring emergency services and additional medications to alleviate symptoms while waiting for authorization of the correct medication that will control the illness or disease.