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EDITORIAL COMMENT

      Prior authorizations (PAs) are a means by which insurance companies ostensibly regulate the overutilization of costly medications and medical services. While controlling health care costs is an important consideration, PAs are increasingly criticized for the administrative burdens placed on health care practices and providers, with resultant delays in patient care and the potential for harm when patients are unable to get their indicated treatments/services. Acknowledging these criticisms while balancing the need for prudent resource management, a consensus statement for improving the PA process was put out in 2018 by the American Medical Association (AMA), American Hospital Association, America's Health Insurance Plans, the American Pharmacists Association, Blue Cross Blue Shield Association, and the Medical Group Management Association emphasizing the need for reform.

      American Medical Association. consensus statement on improving the prior Authorization Process.https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/arc-public/prior-authorization-consensus-statement.pdf. Published 2018. Accessed June 12, 2022.

      Despite such efforts, the latest AMA survey in 2021 which sampled 1,004 practicing physicians (40% primary care, 60% specialists) found that on average, practices completed 41 PAs per physician per week, with 34% of physicians reporting that PAs led to a serious adverse event, and 30% of physicians reporting that PA criteria are rarely or never evidence based.

      American Medical Association. 2021 AMA prior authorization physician survey.https://www.ama-assn.org/system/files/prior-authorization-survey.pdf. Published 2022. Accessed June 12 2022.

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      References

      1. American Medical Association. consensus statement on improving the prior Authorization Process.https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/arc-public/prior-authorization-consensus-statement.pdf. Published 2018. Accessed June 12, 2022.

      2. American Medical Association. 2021 AMA prior authorization physician survey.https://www.ama-assn.org/system/files/prior-authorization-survey.pdf. Published 2022. Accessed June 12 2022.

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