The Effect of Prior Authorization on Clinical Decisions

Abstract

It may seem intuitive to clinicians like myself, but prior authorization (PA), in its current state, significantly affects clinical decision making. If used as originally intended, PA can have a positive effect, including maximizing therapeutic value, ensuring safe prescribing, and containing costs [1]. PA can, for instance, steer a provider to a less expensive but equally effective medication or alert them to a significant contraindication. Both scenarios benefit the patient by improving their likelihood of treatment adherence and improved health. However, prior authorization requirements can also have a detrimental effect on clinical decisions and patient health [2].