Dr Sabin Dang Outlines the Additional Practice Burdens of Prior Authorizations

While prior authorizations are put in place to ensure appropriate use of expensive therapies, they create a substantial burden for clinicians and patients, said Sabin Dang, MD, ophthalmologist with The Retina Institute.

Transcript

Prior authorization (PA) is supposed to ensure appropriate use of expensive therapies, such as anti-VEGF, but what additional cost and team burdens are PAs putting on practices?

So, prior authorization in ophthalmology, and broadly in medicine, has created additional barriers for us, as clinicians, to provide care to our patients. We do understand that, you know, these therapeutics do have a high cost associated with them, so there is a system needed to be put into place to monitor appropriate use of those medications.

What we find in our field is that these prior authorizations are creating a substantial burden for clinicians and patients. Specifically, the amount of administrative time a staff is required to spend in order to secure those prior authorizations has become very substantial. But additionally, patient's care may be delayed by going through that process. So, we could have a patient who comes in, the physician has identified treatment is needed, they go through the prior authorization process, and instead of the patient being able to get same-day treatment, they instead have to take another day off work, ask the relatives again for another ride so that they can come back to the office to get a treatment that the physician had already thought was necessary.

The combination of those 2 things are creating fewer available appointments for us to care for other patients, but additionally incurring a substantial amount of administrative cost and time in order to provide appropriate treatment.