Health Affairs November 24, 2025
Prior authorization (PA) is a utilization management technique used by health insurers that requires providers to seek approval from the insurance plan before the plan will agree to pay for a covered procedure, service, or medication. Insurers can leverage PA to control health care spending, both by negotiating lower prices for services that they do not subject to PA and using PA to limit access to certain higher-price services.
While insurers contend that PA also allows them to ensure care is clinically appropriate, PA has been linked to adverse health outcomes for patients, as well as delays and frustration in the US health care system. The administrative costs associated with PA are also significant, and a profitable cottage industry of...
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