COVID-19 brought little relief from prior authorizations

Keith A. Reynolds

Insurers continued to impose bureaucratic barriers as new COVID-19 cases peaked in late 2020.

Despite the strain placed on physicians by the COVID-19 pandemic, insurers continued to impose prior authorization requirements which delayed care and hurt some patients.

According to a news release from the American Medical Association (AMA), a new survey showed that nearly 70 percent of the 1,000 respondents showed that health insurers had either reverted to prior authorization policies or never relaxed them to start with.

“As the COVID-19 pandemic began in early 2020, some commercial health insurers temporarily relaxed prior authorization requirements to reduce administrative burdens and support rapid patient access to needed drugs, tests and treatments,” AMA President Susan R. Bailey, MD, says in the release. “By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care.”

A further 94 percent of respondents report that they’ve experienced care delays while awaiting prior authorization for needed care. Meanwhile 79 percent report patients abandon treatment due to authorization fights with insurers, the release says.

These authorization requirements have led to serious adverse effects on a patient in the care of 30 percent of the respondents. Nearly a quarter, 21 percent, of respondents seeing their patient hospitalized, 18 percent reported their patient experiencing a life-threatening event or intervention to prevent permanent damage, and 9 percent reported their patients experienced disability or permanent damage, defect, or death, according to the release.

Many physicians doubt the claim that these prior authorization criteria reflect evidence-based medicine, with only 15 percent of respondents agreeing they often or always do. A further 90 percent of respondents say that prior authorization programs have a negative on patient health outcomes, the release says.

Another 85 percent say that the additional burden of the prior authorizations was high or extremely high while medical practices complete an average of 40 prior authorizations per physician, per week, consuming two business days of physician and staff time. This has led 40 percent of respondents to employ staff members who work specifically on prior authorization tasks, according to the release.