Description
- Abstract:
- Prior authorization is a process used by private health insurance plans to determine whether a specific medical service, procedure, or medication will be covered before a patient receives it. This mechanism may be applied to more complex, higher-cost, or higher-risk interventions, particularly when less expensive or less intensive alternatives may be available. The purpose of prior authorization is to ensure that care is medically necessary, evidence-based, and cost-effective. Growing concerns about prior authorization have garnered the attention of policymakers in recent years. Critics note that prior authorization can delay or deny needed care, increase administrative costs, and drive clinician burnout. This issue brief provides an overview of the use of prior authorization and its impact on the health care system. We then provide an overview of recent federal and state policy actions related to prior authorization.
Access Conditions
- Use and Reproduction
- All rights reserved
- Rights
- In Copyright
- Restrictions on Use
- All Rights Reserved
Citation
Corrie Mook, Jeffrey Marr, Hayden Rooke-Ley, et al.,
"Understanding Prior Authorization: Current Landscape, Practices, and Challenges"
(2026).
Center for Advancing Health Policy through Research (CAHPR) Digital Collection.
Brown Digital Repository. Brown University Library.
https://doi.org/10.26300/psqz-1b42
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Collection:
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Center for Advancing Health Policy through Research (CAHPR) Digital Collection
This collection contains research outputs produced by members of the Center for Advancing Health Policy through Research (CAHPR). Collection DOI: https://doi.org/10.26300/mshb-sp27...