Don't fall for these myths on prior authorization
Insurance companies claim prior authorization lowers costs and improves care. But is that really the case?
Patients and physicians beg to differ with the claims that insurers bandy about when discussing payers’ time-wasting, care-delaying tactics that are designed to control costs. And physicians have the research to back up their position.
Myth: Prior authorization lowers cost
Fact: It’s expensive for doctors—and payers. Formulary restrictions on antipsychotics increased hospitalization risk, inpatient costs and total medical costs, according to a study of 24 state Medicaid programs published in the American Journal of Managed Care. Restrictions increased the number of incarcerated people by 9,920 and upped the costs associated with incarceration by $362 million nationwide. Meanwhile, if a “gold carding” program—a system that allows approved physicians to forgo prior authorizations for certain medications or procedures—were implemented, it would save 5%–10% for payers and physicians, a McKinsey & Co. analysis found.
More data and more at:
https://www.ama-assn.org/practice-management/prior-authorization/don-t-fall-these-myths-prior-authorization