87% of pharmacists say prior authorization delays harm patients, but the average PA still takes 2+ weeks and causes half of patients to abandon treatment entirely

When a patient arrives at a pharmacy with a prescription that requires prior authorization, the pharmacist cannot dispense the medication. The patient leaves empty-handed. The pharmacy must contact the prescribing physician, who must then submit clinical justification to the insurer or PBM, who reviews it on their own timeline. A Surescripts survey found that 87% of pharmacists and 89% of prescribers say prior authorization requirements negatively impact patient health outcomes. More than a quarter of patients waited two weeks to over a month for a decision. Nearly half of pharmacists reported that the process often leads patients to abandon treatment altogether. The human cost is not abstract. A diabetic patient whose insulin requires PA because their insurer changed formularies mid-year goes without insulin for days or weeks. A patient with a bacterial infection whose antibiotic requires PA because the prescriber chose a non-preferred agent does not get to pause their infection while paperwork processes. A psychiatric patient whose antidepressant requires step therapy -- proving they failed on a cheaper drug first -- goes through weeks of medication changes that destabilize their condition. In each case, the PA process assumes that delaying treatment is medically neutral. It is not. Delayed treatment leads to emergency department visits, hospitalizations, and in documented cases, death. Prior authorization persists because it saves insurers money by creating friction. Every patient who abandons treatment is a cost the insurer does not bear. Every physician who switches to a cheaper formulary drug to avoid the PA hassle saves the insurer the price difference. The system is designed to produce exactly these outcomes. In June 2025, major insurers including CVS/Aetna, UnitedHealthcare, and Cigna agreed to provide real-time responses for at least 80% of PAs, but this is a voluntary commitment with no enforcement mechanism, and it does not address the fundamental problem: the decision about whether a patient receives their prescribed medication is made by an entity whose financial interest is served by denying or delaying it.