Prior authorization is a health plan cost-control process that the AMA survey research shows leads to delayed and abandoned care, negatively affecting patient outcomes. The average physician practice completes 39 prior authorizations per physician, per week, and doctors and their staff spend nearly two business days a week completing such authorizations. More than 90% of physicians report care delays while waiting for insurers to authorize necessary care, and 80% say prior authorization can lead to treatment abandonment. Almost 30% of physicians report that prior authorization has led to a serious adverse event – and, this includes hospitalization, disability or death for a patient in their care. The AMA continues to advocate for physicians and patients arguing that prior authorizations are overused, costly, inefficient, opaque and responsible for patient care delays. To date, the AMA has succeeded in finalizing Centers for Medicare and Medicaid Services (CMS) reforms to the prior authorization requirements and overall process; and, supported more than a dozen states in enacting laws that reduce care delays and wasted time due to prior authorization requirements. [AMA, March 2025]
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