When patients step in on prior authorization, care delays rise

Clinical takeaway: Patients and caregivers who must actively navigate prior authorization may be at particularly high risk for care delays and treatment disruptions. Clinicians should proactively identify and support these individuals when PA requirements arise.

Prior authorization (PA) is increasingly shifting administrative work onto patients and caregivers, and this study suggests that those who become directly involved are more likely to experience delays, denied care, and negative perceptions of the process.

A national survey of 997 US adults with recent prior authorization experience found that direct patient or caregiver involvement in the PA process was associated with worse care experiences and more frequent delays.

Among patients reporting PA experience, 62% said they became directly involved in the process, such as contacting insurers, pharmacies, or healthcare teams, filing appeals, or seeking outside assistance. Just over half (52%) ultimately received the originally recommended care, while 21% reported that PA was approved but they received a different treatment than initially prescribed. More than one-quarter (27%) experienced a denial, and 59% reported delays in care.

Patients who became directly involved in PA were more than twice as likely to report that recommended care was not approved or received, that PA represented a moderate or serious problem, and that care was delayed.

Caregiver involvement was even more common, reported by 82% of respondents managing PA on behalf of a family member or friend. Among these caregivers, 76% reported delays in care, 27% reported denial of recommended care, and 38% described PA as a moderate or serious problem. Direct caregiver involvement was associated with more than a twofold greater likelihood that recommended care was not approved or received and that PA was viewed as a significant problem.

“Our findings have implications for clinical practice and policy, highlighting the importance of including caregivers in patient-focused insurance-navigation training,” the authors wrote.

Because the convenience-sample findings were self-reported and observational, they cannot establish that direct involvement caused worse outcomes; involvement may instead signal an already complicated or previously denied case.

Source: Thom B, et al. (2026 July 23) JAMA Netw Open. Patient and Caregiver Involvement With Prior Authorization and Care Delivery and Delays