Advocacy in action: Fixing prior authorization

Prior authorization is a health plan cost-control process that AMA survey research shows leads to delayed and abandoned care, negatively affecting patient outcomes. The average physician practice completes 39 prior authorizations per physician, per week, and doctors and their staff spend nearly two business days a week completing such authorizations.

More than nine in 10 physicians (93%) report care delays while waiting for insurers to authorize necessary care, and 82% say prior authorization can lead to treatment abandonment. 

More than one in four physicians (29%) report that prior authorization has led to a serious adverse event. This includes hospitalization (23%) or disability or even death (8%) for a patient in their care.  

Meanwhile, 31% of physicians report that prior authorization criteria are rarely or never evidence-based, with 94% saying prior authorization has a negative impact on patients’ clinical outcomes.

Prior authorization is overused, costly, inefficient, opaque and responsible for patient care delays. That’s why we’re standing up to insurance companies to eliminate care delays, patient harm and practice hassles, and why fixing prior authorization is a top priority of how the AMA is fighting for physicians. 

The AMA wants to: 

• Cut the overall volume of prior authorizations. 
• Increase transparency of requirements. 
• Promote automation. 
• Ensure timely care for patients.

The AMA supports these reforms: 

• Volume reduction solutions such as the elimination of prior authorization requirements for regularly approved care, gold-carding programs and other exemption programs. 
• Establish quick response times (24 hours for urgent, 48 hours for nonurgent care).  
• Adverse determinations should be made only by a physician licensed in the state and of the same specialty that typically manages the patient’s condition. 
• Prohibit retroactive denials if care is preauthorized. 
• Make each prior authorization valid for at least one year, regardless of dose changes. For patients with chronic conditions, the prior authorization should be valid for the length of treatment.  
• Require public release of insurers’ prior authorization data by drug, service, and device as it relates to approvals, denials, appeals, wait times and more.  
• Prohibiting plans from requiring prior authorizations when patients switch plans before they can get coverage for ongoing care. 

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Learn about the AMA’s prior-authorization reform initiatives. 

The AMA has: 

• Achieved finalization of Centers for Medicare & Medicaid Services (CMS) regulations making important reforms to prior authorization to cut patient care delays and electronically streamline the process for physicians.
• Supported more than a dozen states in enacting laws in 2024 that reduce care delays and wasted time experienced by patients and physicians due to prior authorization requirements.

The AMA is working to: 

• Partner with state medical associations across the country to enact prior authorization reform using AMA model legislation, data, testimony and other resources.

• Recently adopted AMA policy on prior authorization.
• AMA prior authorization physician survey (PDF).
• AMA model bill: “Ensuring Transparency in Prior Authorization Act” (PDF).
• Prior authorization state law chart (PDF).
• AMA Council on Medical Service reports on AMA policy (PDF) and initiatives on prior authorization (PDF).
• FixPriorAuth.org shows how prior authorization affects patients, physicians and employers and enables you to share your story.

Visit AMA Advocacy in Action to learn more about the advocacy priorities the AMA is actively working on.

The AMA works to generate support for policies critical to the nation’s health care system—and we can’t do it without your help. Learn more about ways to get involved with AMA advocacy.