How does prior authorization impact your care?
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Patient visits a health care provider to seek treatment.
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Health care provider and patient form plan, including medicine or treatment.
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Insurance companies use “prior authorization” to prevent patients from immediately accessing the treatment they need.
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Patients and providers navigate “prior authorization” red tape to gain access.
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Patients’ health deteriorates and conditions worsen before insurers finally get out of the way.
Inequitable impacts barrier to necessary care
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Prior authorizations disproportionately impact Coloradans with disabilities or low incomes, women, and people of color
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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
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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