Prior authorization is a utilization management tool – its intention is to keep costs in check while ensuring patients receive appropriate treatments. But in a recent survey, 86% of respondents said prior auths actually resulted in increased use of resources, leading to waste rather than the cost savings they’re intended to create. 

And yet, prior authorization is still very much a part of the American healthcare system. According to the survey referenced above, healthcare practices complete 45 prior authorizations per physician per week on average, with staff spending an average of 14 hours weekly on prior authorizations. Payors say they’re taking action to improve the process … but is the process really improving? What can we learn from prior authorization data collected directly from payors?

Those are some of the questions we sought to answer in a new report, and which we’re sharing some of the answers to below.

The fax machine’s grip on healthcare remains strong

Prior authorization has traditionally held the lowest electronic adoption rate of all administrative transactions in healthcare, underscoring the burden it places on the entire healthcare system. 

It may sound counterintuitive considering the significant digital advances over the last few years, but there’s actually been an increase in the number of payors the Infinitus AI agent calls that accept prior authorization submissions via phone and fax in the last year. And still, not all payors accept requests in the same formats, which adds further complexity.

A chart showing the accepted submission methods of prior authorization in 2023 and 2024: phone, fax, website, mail, and email.

The prior authorization waiting game

According to those Infinitus surveyed this summer, delays in receiving a determination can lead patients to increases in anxiety; electing to switch to different therapies; as well as missing appointments or treatments. But no national standard for turnaround time currently exists, and legislation aimed at improving turnaround time that is scheduled to go into effect in 2025 doesn’t impact all types of insurance plans.

The good news is our data showed that the turnaround time to receive a prior authorization determination isn’t getting longer despite a “dramatic increase” in its use

A graph showing the average turnaround time for prior authorizations in 2023 and 2024.

The truth about prior authorization

To learn more about the current state of prior auth, download our report The truth about prior authorization. By analyzing data collected directly from payors by the Infinitus AI agent, we were able to understand the state of:

  • Step therapy: As prior auth use increases, have step therapy – sometimes known as fail first – requirements increased as well?
  • Renewal processes: For recurring treatments, patients likely need a prior authorization at least once every year… but in many cases, standard renewal processes may not exist.
  • Approved sites of care: Are patients having to travel further to receive care from approved providers?
  • And more …

Download The truth about prior authorization now to understand more about what data collected directly from payors can teach us about healthcare’s big burden.