Prior authorization (PA) eats up plenty of time and requires manual input that diverts valuable time and resources away from treating patients. PA can postpone treatment and contribute negative clinical outcomes, according to the AMA.

Tips to help physicians reduce the prior authorization burden in their practice. American Medical Association. 2015.

Although the AMA has been lobbying to decrease the negative impacts of PA on patients and physicians and achieve a scaled-back, streamlined, automated process, it realizes that at least for the near future, the rigamarole is necessary.

So it’s best for physicians to minimize the inconvenience of PA and help secure approval by following certain tips.

The facts about PA

These responses are based on input from physicians and pharmacists employed by the insurer. The physician or patient can appeal PA decisions.

On its website, insurer Cigna promotes PA for various reasons.

What is prior authorization?. Cigna. 2022.

Cigna claims PA decreases treatment costs by necessitating that lower-cost alternatives be tried first.

It also decreases the risks of drug-drug interactions and curbs the use of unnecessary treatments or addictive medications, according to the insurer.

Tips on facilitating PA

1. Check on PA requirements before prescribing or treating patients. This will help prevent denials or forfeited payments, while minimizing prescription delays and decreasing patient non-adherence.

2. Establish the practice of entering all documentation needed for a PA in the patient’s chart. This will minimize the physician’s PA involvement, as other staff members could retrieve the information and prepare the PA. Having complete information also reduces the need for another patient visit to fill in missing data.

3. Select the PA option that’s most efficient based on insurer options.

4. Follow up with payers to make sure the PA request was received and is on track. Make sure no forms are lost or delayed.

5. When PAs are denied, submit organized, concise, well-written appeals. They can boost your approval success rates and minimize potential delays.

An FPM blog posting offered the following additional tips:

Thirteen ways to reduce the burden of prior authorizations. Quick Tips: A Blog from FPM Journal. June 27, 2019.

• Formulate master lists of medications and interventions that require PA. Break them down by insurer, and program your EHR system to flag anything requiring PA.

• Delegate certain staff to handle PA. This makes them experts and expedites the process.

• Use pre-populated forms for PA as needed.

• Use the insurer’s own forms, listing codes and diagnosis conventions. Use online forms to make the process faster; getting PA over the phone is usually very time-consuming.

• Rely on evidence-based guidelines when pursuing PA.

• Seek out lower-cost alternatives that may not need PA. Go for generic drugs, which usually don’t require PA.

• Use the insurer’s peer-to-peer process and engage its physicians or medical directors to address your questions.

• Make sure your patients understand the PA process and coverage limitations. By educating them, they’ll direct frustration regarding denials toward the insurer, which could facilitate change.

• For a denial, defend your position vigorously by sending letters supporting a patient’s need for certain medications and the dangers of switching them.