Nearly half of insured adults have faced prior authorization requirements in the past year
A recent national poll from the PAN Foundation’s Center for Patient Research finds that nearly half (48 percent) of insured adults say their health insurance plan has required prior authorization in the past year. Of those, two-thirds (67 percent) of adults say these prior authorization requirements delayed their access to prescribed medication or medical treatment—most commonly up to two weeks (45 percent).
Other findings include:
- Medicare Advantage plans (44 percent) are significantly more likely than traditional Medicare plans (27 percent) to require prior authorization.
- About one-fifth of adults said prior authorization requirements resulted in delayed access to their prescribed medications (22 percent), their prescribed medication changing (22 percent), or their prescribed medication or treatment being denied (18 percent).
- One-third (35 percent) of adults said prior authorization requirements caused them increased stress or anxiety, while one-fifth (18 percent) said it caused them increased feelings of depression. Notably, 10 percent said these requirements led to a decline in their overall health and 7 percent said these requirements led to unplanned hospitalization.
“Our latest poll highlights the challenges patients face when their insurers and health plans use prior authorization to reduce payer spending,” said Amy Niles, Chief Mission Officer at the PAN Foundation. “This restrictive utilization management practice can harm patients by disrupting care delivery and negatively impacting clinical outcomes. PAN continues to call on Congress, along with public and private insurers, to put patients first and curb the use of prior authorization and other restrictive utilization management practices.”
Prior authorization, which is a cost-control process used by health plans, requires patients or healthcare providers to secure pre-approval from the patient’s health plan before receiving coverage for a prescribed medication or treatment. For far too many patients this requirement delays their treatment and often negatively impacts their health, as these poll results highlight. The PAN Foundation, alongside our partners and advocates, will continue to voice our support for improving patient care by curbing this harmful practice.
Polling methodology: This poll was conducted between May 13-15, 2024, among a sample of 2,200 adults. The interviews were conducted online, and the data were weighted to approximate a target sample of adults based on age, gender, race, educational attainment, region, gender by age, and race by educational attainment. Results from the full survey have a margin of error of plus or minus 2 percentage points.
About the PAN Foundation
The PAN Foundation is an independent, national 501 (c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic, and rare diseases with the out-of-pocket costs for their prescribed medications.
Since 2004, we have provided more than 1.1 million underinsured patients with $4 billion in financial assistance. Partnering with generous donors, healthcare providers and pharmacies, we provide the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Learn more at panfoundation.org.