How does prior authorization impact your care?
Patient visits a health care provider to seek treatment.
Health care provider and patient form plan, including medicine or treatment.
Insurance companies use “prior authorization” to prevent patients from immediately accessing the treatment they need.
Patients and providers navigate “prior authorization” red tape to gain access.
Patients’ health deteriorates and conditions worsen before insurers finally get out of the way.
Inequitable impacts barrier to necessary care
Prior authorizations disproportionately impact Coloradans with disabilities or low incomes, women, and people of color
One in three patients report either delaying or forgoing needed health care because of an administrative task (like prior authorizations)
25% of patients in fair/poor physical health status report that their health insurance denied or delayed their necessary medical treatment, service, or drug
Chronic disease patients who are Black or Hispanic experience prior authorization denials at a 19%-40% greater rate than white patients
The Prior Authorization Crisis by the Numbers
94% report that prior authorization delays patient care.
80% report that prior authorization can lead to treatment abandonment.
33% report that prior authorization has led to a serious adverse event for a patient including hospitalization and death.
64% of physicians report that prior authorization has led to ineffective initial treatments (i.e., step therapy).
62% of physicians report that prior authorization has led to additional office visits.
46% of physicians report that prior authorization has led to immediate care and/or ER visits.
Source: 2022 American Medical Association prior authorization physician survey