Why Prior Authorization Still Takes So Long, Even After Reform Pledges

Thirteen hours. That's how much time the average physician's practice now spends every week just arguing with insurance companies over care that's already been prescribed — not treating patients, chasing paperwork on their behalf.

The number comes from the 2025 AMA Prior Authorization Physician Survey, released in May by the American Medical Association, and it lands at an awkward moment. A year earlier, roughly 60 health insurers had publicly pledged to streamline prior authorization, the approval step insurers require before they'll pay for certain drugs, tests or procedures. The AMA polled 1,000 practicing physicians ahead of the first major deadline for that pledge. Only one in three said they expected it to make a meaningful difference.

What is a prior authorization, exactly?

It's an approval of coverage from the insurance company, not the doctor. A physician can write a prescription or order a procedure, and the insurer can still say: not yet, prove it's necessary first. GoodRx notes that insurers typically reserve the requirement for brand-name drugs with a generic alternative, high-cost specialty medications, treatments outside standard dosing, or anything they consider cosmetic or non-essential. Pay in cash, and none of it applies — the restriction only bites when the claim runs through insurance.

Why is my prior authorization taking so long?

Because two separate parties have to move, and only one of them is in a hurry. A prescriber's office has to submit clinical justification; the insurer then has its own internal review clock, which varies by company and by drug. GoodRx's guidance puts routine requests at one to three business days, some insurers at five to seven, and complex or specialty medications at "a few weeks" if an appeal gets involved. Urgent, life-threatening cases can be reviewed within a day. Electronic submission has narrowed that gap considerably — the platform CoverMyMeds says most electronic requests get a determination within about two hours, versus the multi-day slog of fax and phone — but plenty of practices still work the old way.

Paperwork gaps do the rest of the damage. Missing forms, an incomplete diagnosis code, a drug that isn't on the plan's formulary — any of it resets the clock, and it's the patient who's left waiting at the pharmacy counter.

Why do insurers say they need to approve it first?

Their stated case is cost and safety: confirm a treatment is medically necessary, steer patients toward a cheaper alternative first, and catch overuse of medications that carry real risk. That's a defensible goal in the abstract. It's the execution physicians are furious about.

The AMA's new numbers are blunter than the industry's talking points. Ninety-five percent of surveyed physicians say prior authorization delays access to necessary care. Seventy-nine percent say patients abandon treatment altogether rather than fight the process. Twenty-six percent — more than one in four — report a prior authorization denial leading to a serious adverse event, including hospitalization, permanent impairment or death. Those aren't complaints about inconvenience; they're a description of a rationing mechanism with a body count nobody is officially tracking.

"Physician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises. When only a third of physicians expect meaningful impact — and so few report that health plan reviewers are appropriately qualified — it highlights a credibility gap that won't be closed with vague or partial measures."

Bobby Mukkamala, M.D., American Medical Association president

Part of that credibility gap is specific and checkable. As part of the 2025 pledge, insurers promised every medical-necessity denial would get reviewed by a licensed, qualified clinician. Only 24% of physicians say that's actually happening. Among doctors who go through peer-to-peer review calls — where a physician is supposed to argue the case to a clinical counterpart at the insurer — just 16% say the person on the other end of the line often or always has the right qualifications to judge it.

Which insurers get the worst marks from doctors?

UnitedHealthcare topped the AMA's list, with 75% of physicians rating its prior authorization burden "high" or "extremely high," followed by Humana at 65%, Anthem/Elevance and Aetna tied at 61%, Cigna at 59% and Blue Cross Blue Shield at 56%. That's six of the country's largest insurers, all landing in the same uncomfortable neighborhood.

The irony the AMA keeps hammering is that prior authorization is sold as a cost-control tool, yet 88% of physicians say it increases overall health spending rather than reducing it — through ineffective first-line treatments patients are forced to try, extra office visits to document necessity, and emergency care or hospitalizations that a delayed treatment made worse. Denying care up front doesn't make the underlying medical problem disappear; it often makes it more expensive to treat later.

Can you speed up a prior authorization?

Sometimes. An urgent request, when a condition qualifies, can force a same-day review. Some pharmacies will let a patient pay out of pocket and seek reimbursement once approval comes through, though that's a real financial risk if the request is later denied. And increasingly, the fastest path is simply an electronic one — paper and fax are, for practical purposes, the slow lane now.

None of that fixes the structural problem the AMA is describing: a system where three in four physicians say denials have gotten worse over the past five years, and six in 10 worry that insurers' growing use of artificial intelligence in claims review will push denial rates higher still, not lower. The 2025 pledge set implementation deadlines running through 2027. Whether that timeline produces anything different from the pledges that came before it is, according to the doctors who live with the process daily, still very much an open question.