Prior Authorization: Moving Toward Zero.

Abstract

Depending on who you ask, prior authorization is a primary driver of administrative burden and delayed medical care or an essential tool for enhancing safety, improving health outcomes, and reducing expenses. Despite clear clinical criteria outlining requirements for timely care and utilization management committees, there remain vast differences in the ways prior authorization is used nationwide. Detailing examples from three provider-aligned health plans, the authors argue that there is a proper role for prior authorization in the current health care environment, but they contend that the path should be for limited and reduced use, moving closer to zero.