NHC Report: Exploring the Burden of Prior Authorization on Patients with Chronic Disease


Executive Summary

The United States’ health care system contains a network of insurance plans and processes that are frequently difficult for patients to navigate. Practitioners are often required to work with health care insurers to determine the medical necessity of a drug or service through a process called prior authorization (PA). While PA is often intended to protect patients, it can be a lengthy process that delays treatment and impacts the quality of care. To alleviate these challenges, improve workflow and PA use, some federal and state level policies have been implemented to address the shift towards electronic health records and amend the overall PA process. To help the patient community follow and understand these policy changes, the National Health Council (NHC) has developed this report detailing current PA policies and recommendations as of November 2023. Watch for future NHC Reports on additional Utilization Management techniques, such as Step Therapy, and other health systems’ practices that create barriers to patient access to medicines and care.