The Financial and Administrative Impact of Prior Authorization for Medications

What is Prior Authorization (PA)?

• Process to obtain approval for treatments, medications, or procedures before coverage.

Why PA is Important

• Controls costs, ensures necessary treatments, and minimizes delays in patient care.

Challenges

• Patients: PA delays lead to high costs and untreated conditions.
• Providers: Time spent on PA approvals reduces focus on patient care.
• Payers: Short-term savings from PA delays increase long-term costs.

Practolytics’ Role

• Automates PA workflows, reducing delays and administrative burden.

Key Insights

• 70% of providers face PA delays.
• AI tools cut PA submission time by 50%.

PA in Medication

• Used for medications like insulin pumps, biologics, and chemotherapy drugs.
• Helps manage costs for chronic illnesses and high-risk diseases.

Financial Impact of PA

• Patients: Delays lead to higher costs and worse health outcomes.
• Providers: Average of 14 hours per week spent on PA tasks.
• Payers: Delays result in long-term cost increases.

Administrative Challenges

• Complex, payer-specific rules lead to inefficiency and errors.
• Practolytics: AI reduces denial rates by 25%, automates submissions, and integrates with EHRs.

Conclusion

• Automation tools like Practolytics streamline PA, reduce administrative costs, and ensure timely care.