Prior authorization’s growing footprint
Facts at your fingertips
By Emily Margosian, assistant editor, June 1, 2020
While prior authorization requirements have existed since the 1980s, the policy’s impact on physicians, patients, and the larger health care system has evolved considerably over the past four decades. “Physicians expect challenges when prescribing newer specialty drugs, but major formularies in some instances now require prior authorization/step therapy even for established generic products that have no obvious lower cost substitutes,” writes a 2020 JAMA viewpoint (323(8): 703-704). The burden posed by prior authorizations is particularly concentrated in the United States, which spends far more (nearly double) on health care-related administrative tasks than virtually any other country in the world (JAMA. 2018; 319(10): 1024-1039).
How can physicians take some of the pain out of prior authorizations? The AAD’s popular online letter generator allows dermatologists to easily create appeal letters to overturn denials for prior authorizations.
See the graphic below for a timeline of prior authorization’s evolving impact.
