Precision Medicine at a Standstill? The Challenges of Prior Authorization in Genomics
- Prior Authorization Delays Care: Genomic testing is crucial for timely treatment, especially for cancer and rare diseases, but prior authorization (PA) often causes harmful delays.
- High Denial Rates: Around 40% of PA requests for genetic tests are initially denied, creating frustration and added workload for doctors and patients.
- Inconsistent Insurance Policies: Different insurers have varying PA rules, leading to confusion, underuse of advanced tests, and administrative burdens.
- Heavy Workload for Providers: Doctors spend nearly two workdays a week managing PAs, diverting time from patient care.
- Financial Barriers for Patients: Even approved tests can be expensive, limiting access and delaying proper treatment.
- Emerging Solutions: AI tools, CMS policy updates, and standardized guidelines aim to streamline and speed up the PA process.
- How Practolytics Helps: Practolytics simplifies PA with expert support, automation, error-free submissions, and up-to-date compliance, enabling faster access to life-saving genomic care.