Patients say prior authorizations disrupt care, add to burden

Patients echo provider complaints about prior authorizations

The assessment of the free-text patient comments revealed the following four themes:

• Blinded navigation, or the feeling of being blindsided by an unexpected prior authorization requirement.
• Intersecting burdens, or the dissatisfaction of both patient and provider having to advocate to get needed medication.
• Interference with care, or the delays to treatment faced by some patients completing prior authorization.
• Broken system, or the general notion that approval from a payer is indicative of a broken healthcare system.

"To patients, prior authorization is a confusing, opaque process that adds to the administrative, psychosocial and financial burdens of cancer care," the report authors explained. "The intersection of these burdens amplifies the physical, psychological and monetary impact on patients, who must also comanage the symptoms of their disease and the adverse effects of their cancer treatments."

Of particular concern was the question of health equity and whether all patients experience prior authorizations the same way. For instance, one patient respondent reflected on their own above-average health literacy and how limited health literacy of other patients must exacerbate prior authorization experiences.

“I am in medicine and know how to navigate the system and these issues make me cry and get frustrated very often, I can't imagine how an elderly person or how someone who isn’t fluent in English gets by," the patient said.

Navigating prior authorizations requires patients to have at least adequate health literacy (the Center for Health Care Strategies says 9 in 10 adults struggle with this), as well as technological know-how. Given the growing digital divide in medicine, the researchers remarked that experiences with prior authorizations are likely ripe for health disparities, although quantifying this was outside the scope of their study.

Notably, patient sentiments echo those expressed by clinicians in a provider portion of the survey. For example, about a third of the 730 oncologists included in the assessment said that prior authorizations have led to an adverse patient safety event for one of their patients, and 7% said they've led to patient death.

Both patient and provider dissatisfaction with prior authorization is grounds for more advocacy and policy change, the authors concluded.

This comes as more health insurance companies publicize plans to end their prior authorization requirements. Earlier this month, Humana unveiled plans to eliminate a third of prior authorizations for outpatient services by 2026. That came on the heels of dozens of health insurers promising to simplify the prior authorization process.

It is not yet clear how these changes will affect patients and providers.

Sara Heath has reported news related to patient engagement and health equity since 2015.