The Prior Authorization System Fails Patients. There's a Better Way

The current prior authorization (PA) process is an administrative failure. Beyond the excessive time and paperwork required, this workflow is a barrier to patient care. More than 20% of consumers in a D2 Solutions survey¹ reported delays in starting their medication because of PA approval issues. One in 10 never even picked up their prescription.

Care delays are the tip of the iceberg. A systematic review published in the American Journal of Medicine² found that authorization requirements were associated with worsening diseases, avoidable and prolonged hospital stays and lower rates of disease-free survival. According to the American Medical Association,³ 29% of physicians report that a PA has led to a serious adverse event for a patient.

A system that forces patients to wait days or even weeks for medication is unacceptable. PA workflows are labor-dependent and low-efficiency, but they don’t have to be. If the industry wants patients to start the right treatments sooner, PAs need to be more efficient. This article will detail how existing technologies can alleviate the struggle.

The outdated PA workflow

The prior authorization process is difficult, frustrating and costly. The standard plays out in this way:

• A provider orders a treatment.
• Staff determine if PA is required.
• Staff gather clinical documentation and fill out forms.
• The provider submits the request to the payer.
• The payer reviews the request.
• The payer issues a decision.
• The provider initiates an appeal, if needed.

The operation can break down at any of these steps. It may take the provider’s office multiple days to submit the request. The forms could contain errors or incomplete information. Insurance reviews can drag out, especially during high-volume periods like the beginning of the year. PAs can be inappropriately denied, requiring an extended appeal process.

PAs are the leading cause of administrative burden for physicians. Doctors and their staff complete an average of 39 PAs per physician³ each week, totaling more than 13 hours of paperwork. More than 90% of medical practices⁴ have hired or shifted staff to manage the increase in requests. Health care is already grappling with a staffing shortage.⁵ Dedicating limited clinical resources to an archaic manual process stretches teams even thinner.

Artificial intelligence (AI) and automation capabilities can streamline and accelerate PA requests.

Creating a more efficient way to approve coverage

PAs are a prime technology use case. The forms are extensive, with many fields interdependent on other answers. Providers need to apply the clinical criteria correctly, select the right pathways and collect the necessary documentation.

Each payer also has its own formulary, documents and requirements, so staff must constantly switch rulesets when making requests. With 39 PAs a week per doctor, the process creates an enormous operational and mental strain.

AI automates the navigation of this paperwork. The first step is autopopulating a patient’s basic information and pulling payer and coverage data to determine if a PA is required. Then, the system guides form completion based on the policy’s guidelines.

Software can actively monitor staff’s inputs, flagging mistakes and denial risks. For example, alerting staff that answering “no” to a particular question will likely make the patient ineligible.

AI also follows the form’s logic and adapts the paperwork based on the answers. If selecting "yes" to a specific question makes a later section irrelevant, the system tells the staff they can skip it. The team saves time by only filling out what is absolutely needed without missing anything important.

Gathering clinical information for submission is cumbersome, but AI can provide a specific checklist for each request. The team can also run a final validation check to catch any issues before filing it.

This technological support reduces the burden on health care staff while minimizing avoidable denials, appeals and resubmission.

Teams can leverage analytics to uncover approval trends and bottlenecks. They can pinpoint the most common reasons for denials, such as failing to meet step therapy requirements or properly navigate form logic, and adjust workflows accordingly. The visibility also allows staff to identify inconsistencies, such as high denial rates from one particular payer or for one particular medicine. With this insight, providers can significantly improve their overall approval success rates.

Supporting patients needing approval

Most patients don’t know much about the PA process. All they want to know is if their medicine will be covered, how much it costs and when they can get it. Waiting for approvals can be stressful. In the D2 Solutions survey, nearly half of respondents experienced some sort of negative emotion when starting a new prescription, including anxiety, confusion and feeling unsupported.

By leveraging patient engagement technology, pharmacists and doctors can improve communication to alleviate stress. These strategies may include text or email updates on the status, alerts about approval and cost and other information to help the patient feel informed and empowered. AI can automate the messages so staff don’t have to continuously monitor dozens of requests. This capability is also useful for supporting medication adherence after approval.

Overcoming resistance to technology

Health care organizations have been slow to adopt technology due to concerns about patient impact, data privacy and legacy systems. Facilities can reduce risk by focusing on one inefficient workflow and layering an AI tool on top of an existing information hub. The algorithm works with the system data without changing any infrastructure.

PA is the perfect place to start this targeted approach. Organizations already have access to the critical information — patient eligibility, benefits, clinical requirements, etc. They just need a tool to collect and process it.

Targeted AI deployment in PA workflows maintains existing privacy practices and avoids disrupting the entire system.

Health care providers’ ultimate goal is to improve patient outcomes. This happens through one-on-one interactions and prompt treatment, not hours of paperwork and confusing, lengthy approval processes. By adopting technology for the PAs, patients get faster drug access for more effective treatment.

Dean Erhardt is the president and CEO of D2 Solutions

References

1. D2 Solutions. 21% of patients delay therapy due to access barriers: 2026 patient survey. D2 Insights blog. March 31, 2026. Accessed April 17, 2026. https://blog.d2rx.com/d2-insights/21-of-patients-delay-therapy-due-to-access-barriers-2026-patient-survey-by-d2-solutions

2. Murphy J, Beauchamp N, Sun KJ, et al. Adverse effects of health plan prior authorization on clinical effectiveness and patient outcomes: a systematic review. The American Journal of Medicine. 2025;139(1):24-32. Accessed April 17, 2026. https://www.amjmed.com/article/S0002-9343(25)00553-4/fulltext

3. American Medical Association. 2024 prior authorization physician survey. 2024. Accessed April 17, 2026. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf

4. Medical Group Management Association. Prior authorization 2024 issue brief. 2024. Accessed April 17, 2026. https://www.mgma.com/getkaiasset/7caa3c7f-3e0e-443d-873d-b7194673752e/MGMA%202024%20Prior%20Authorization%20Issue%20Brief_FINAL.pdf

5. National Institute for Health Care Management. Health care workforce shortages. NIHCM Foundation. March 2025. Accessed April 17, 2026. https://nihcm.org/newsletter/rising-healthcare-workforce-shortage