Fixing Prior Authorizations: Eliminating Barriers to Chronic Care Treatment
For patients with chronic conditions like diabetes, asthma, or heart disease, doctor-recommended long-term treatments aren’t just important—they’re a lifeline.
“[I wish] insurance companies would just let providers do their job!” one frustrated mother, whose son’s asthma had been adequately controlled since he was 8, told the Association.
“My son has asthma and was adequately controlled since he was 8 years old. Suddenly this year our insurance decided they wouldn’t pay for his maintenance inhaler anymore and pulmonologist needed to swap it. We swapped but it did not control his asthma as well so PA was needed for Symbicort which did not go through. He is 15 years old now and fighting to get the Symbicort back,” she said.
Unnecessary prior authorizations delay critical care and harm patients, placing profits above patient well-being. For individuals with chronic conditions, these delays can lead to worsening symptoms, increased emergency room visits, elevated healthcare costs and a diminished quality of life.
Eliminating repetitive, bureaucratic prior authorizations for patients with chronic conditions is just one of the Medical Association’s 11 priorities for prior authorization reform aimed at ensuring patients can have uninterrupted access to critical treatments.
Visit www.ALFixPriorAuth.com to share your story about how prior authorization has affected you or your loved ones.
Timely Care Over Bureaucracy: A Call for Prior Authorization Reform
Imagine being in excruciating pain, knowing relief is within reach—only to be stalled by a broken system. A few months ago, a patient needed an MRI to diagnose a severe condition. Instead of timely care, she faced a prior auth roadblock: the MRI request was denied, pending more information. While waiting for another physician to resubmit the request and secure approval, she endured over a month of debilitating pain.
When her condition was finally confirmed, she required epidural injections. Once again, prior authorization delays forced her to repeatedly reschedule treatment. Every rescheduled appointment and every extra day in pain was not just frustrating—it was costly. The delayed care compounded her suffering, likely worsening her condition, and potentially increasing future medical expenses.
This experience highlights why the Medical Association and the 30-plus member coalition for prior authorization reform are strongly advocating for specific changes, including a 24-hour response time for urgent requests and a 48-hour response time for non-urgent ones. Delayed care causes unnecessary suffering for patients and often results in the need for more costly interventions later, exacerbating the strain on an already overburdened healthcare system.
Prior authorizations are meant to ensure appropriate care, but when they create barriers to timely treatment, they fail patients and escalate costs. It’s time to prioritize efficient care over bureaucratic delays—because every day of waiting matters.