US EditionWhat Is Prior Authorization? A Look at the Process and Tips for Approval
UNITED STATES, JUL 30 – The Department of Health and Human Services and over 45 major insurers vow to improve prior authorization, which can delay care from days to weeks, to reduce patient and provider burden.
- Recently, the Department of Health and Human Services and more than 45 of the nation’s largest health insurers announced a shared commitment to improve prior authorization, which insurers use to determine coverage.
- Insurance companies require prior authorizations to ensure medications are safe, effective, and appropriate for patients’ conditions, amid administrative demands that cause delays not driven by clinical need.
- Process timelines vary widely between standard and urgent authorizations, with prior authorization requests taking days to weeks and urgent requests reviewed within a day, despite reliance on fax machines and phone calls.
- Insurers may deny prior authorization requests, leaving patients responsible for medication costs though they can appeal, and pharmacists often assist with copay cards and assistance programs.
- Moving forward, the Department of Health and Human Services and insurers must implement digital reforms, as experts say real progress depends on modern infrastructure and coordinated efforts.
31 Articles
31 Articles
What is prior authorization? A look at the process and tips for approval | News Channel 3-12
Yuri A // Shutterstock What to do if a “prior authorization” is making it difficult to get your medication Have you ever walked into the pharmacy and been told that your prescription requires a prior authorization? But your healthcare professional prescribed something for you, and you brought in your prescription — shouldn’t that be enough? What exactly is a prior authorization, and why can’t you just pick up your prescription? GoodRx, a platfor…
Prior Authorization Reform Is Finally on the Table — Standards Must Be Too
It’s a meaningful step. But declarations alone won’t fix a system still powered by fax machines, phone calls, and inconsistent rules. Real progress will require a modern digital infrastructure, aligned incentives, and coordinated action across both the public and private sectors. The post Prior Authorization Reform Is Finally on the Table — Standards Must Be Too appeared first on MedCity News.
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