Essay on Requirements For Prescription Drugs And Other Medical Procedures

Essay on Requirements For Prescription Drugs And Other Medical Procedures

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Prior-authorization (PA) requirements for prescription drugs and other medical procedures are placing undue administrative burden on healthcare professionals and causing dangerous delays for patients requiring timely access to prescribed therapies. According to an article in Medical Economics citing studies from the Kaiser Family Foundation and the American Medical Association, physician offices spend 868.4 million hours per year working on prior-authorization paperwork for patients (Bendix, 2014). A Health Affairs study found the cost associated with physicians interacting with insurance plans amounts to $69 billion dollars annually - $83,000 per physician (Bendix, 2014).
Extensive prior-authorization processes are also negatively affecting patient care and health outcomes. The prior-authorization process can extend days or weeks in some cases, delaying patients’ access to prescribed therapies and needed medications. Former President of the American Medical Association James Rohack shares, “Intrusive managed care oversight programs that substitute corporate policy for physician 's clinical judgement can delay patient access to medically necessary care. (Robeznicks, 2010)” A 2014 study published in the Journal of Managed Care Pharmacy found a significant negative correlation between prior-authorization restrictions and patient health outcomes (Clark, Happe, Holiday & Young 2014).
The significant administrative burden placed on physician offices coupled with negative health outcomes for patients has seen a number of states draft legislation aimed at improving the prior-authorization process. This paper examines the background and determinants of this significant health problem, reviews the stakeholders, interest groups and a...


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...healthcare consumer. The general public feel the negative effect of prior-authorizations when they are unable to begin treatment in a timely fashion, which can result in detrimental health outcomes. This is particularly a concern for individuals who live with chronic conditions and are heavily dependent on the timely receipt of their medications.
One interest group that speaks for patient rights in the United States is The Patient Advocacy Foundation (PAF). The PAF voices the concerns of patients. Their efforts seek to remove barriers to care such as the tedious PA process. This foundation is dedicated to voicing the concerns and uncertainties of current patients and patients to come, assuring that they are provided the access to the quality medical care and services all American consumers of healthcare expect and deserve (Patient Advocacy Foundation, 2016).


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