Direct Patient and Caregiver Engagement in Prior Authorization Linked to Care Delays
Key Takeaways:
- In a survey of 997 US adults, 28.6% reported engaging in prior authorization (PA) as a patient, and 18.3% reported PA involvement as a caregiver.
- Among both patients and caregivers, those with direct PA engagement reported delays in care, reception of suboptimal care, and negative experiences with PA procedures.
- Policy reforms and assistance programs could help reduce the administrative burden among patients and caregivers.
Researchers conducted a study to examine the impact of patient and caregiver engagement with PA procedures on care management.
Study Methods and Outcomes
Using the Qualtrics Online Panel Platform, investigators surveyed 997 US adults between December 2024 and January 2025. Participants were asked to report their own PA experiences, which was categorized as patient PA. Those who engaged with PA processes for a relative’s or friend’s care management were considered as having caregiver PA experience.
Direct PA involvement included activities such as contacting providers or payers, filing an appeal, or involving an employer or a lawyer.
Outcomes included the magnitude of PA problems (moderate or serious vs no or minor problem), care delays, and reports that recommended care was not approved or received.
Out of the 997 respondents, 286 (28.6%) reported patient PA, with 61.5% having direct PA involvement. Approximately 182 (18.3%) participants reported caregiver PA, with 81.9% having direct PA engagement. Among all participants, 11.3% reported both patient and caregiver PA experience.
Patient PA
Among those with patient PA experience, direct involvement in PA processes was associated with an increased risk of suboptimal or delayed care.
Half (51.5%) of the patients surveyed reported approval and receipt of recommended care. Nearly one fourth (21.0%) of patients reported receiving alternative care despite PA approval, and 59.1% reported care delays.
Approximately 31.8% of respondents reported PA being a moderate or serious problem, and 26.6% received a PA denial.
Caregiver PA
Similar to patient PA experiences, caregivers with direct PA involvement reported increased rates of suboptimal care and delayed delivery.
Nearly half (47.8%) of caregivers reported approval and receipt of recommended care, while 23.6% saw patients receiving care other than what was originally recommended despite PA approval. In addition, most patients (75.8%) experienced delays in care due to PA procedures.
Over one third (37.9%) of care givers reported PA processes as a moderate or serious problem.
Implications for Managed Care
These findings illustrate an association between direct PA engagement among patients or caregivers and poor care management. Those with direct PA involvement reported delays in care, reception of non-recommended care, and frustration with PA processes.
According to the authors, “Policy changes, such as limiting types of care requiring PA, increasing transparency, or requiring state-level consumer-assistance programs, may decrease PA-related administrative burdens for patients and caregivers.”
Reference
Thom B, Slater VE, Lund JL, et al. Patient and caregiver involvement with prior authorization and care delivery and delays. JAMA Netw Open. 2026;9(7):e2624901. doi:10.1001/jamanetworkopen.2026.24901
