The Prior Authorization Burden: What the 2024 AMA Data Means for Your Practice

Every year, the American Medical Association surveys a nationally representative sample of practicing physicians about their experience with prior authorization. The 2024 survey — completed by 1,000 physicians across primary care and specialty settings — is the most recent in a series that has tracked this problem since 2017. The numbers are not improving.

The Volume Problem

The average physician practice completed 39 prior authorization requests per physician per week in 2024. That is roughly 8 per day, assuming a standard five-day week. More than 40% of practices now employ staff whose entire job function is managing prior authorizations — a role that did not exist as a standard staffing category fifteen years ago.

The time cost adds up quickly. Physicians and their staff spend approximately 13 hours per physician per week on PA-related work. At a practice with four physicians, that is 52 hours per week — more than a full-time employee — consumed by a process that does not generate revenue, does not improve clinical outcomes, and is largely invisible on a practice's income statement.

The CAQH Index, which tracks administrative transaction costs across the healthcare industry, estimated total annual PA administrative costs at $1.3 billion in 2024 — a 30% increase over 2022 figures. MGMA data from 2025 found that PA-related staffing costs have increased 43% since 2019. These are not small numbers.

The Clinical Cost

Administrative burden is measurable. The clinical cost is harder to quantify but more consequential. The 2024 AMA survey found that 93% of physicians report PA delays in patient access to necessary care. Eighty-two percent report that patients commonly abandon their recommended course of treatment because of PA-related friction — the callbacks, the hold times, the documentation requests.

Twenty-nine percent of physicians report that prior authorization has led to a serious adverse event for a patient in their care — including hospitalization, permanent bodily damage, or in some cases, death. When a third of physicians can name a specific patient who was harmed by an administrative process, the process has moved from bureaucratic irritant to clinical hazard.

A 2025 study published in JAMA Network Open examined 19,725 Medicaid patients across two states and found that procedural prescription denials were directly associated with increased emergency department visits and hospitalizations within 60 days of the denial. The denial did not save money. It deferred and amplified costs while patients went untreated.

Where the Time Actually Goes

Prior authorization is not a single task — it is a workflow. Before a PA request can even be submitted, someone needs to confirm that the drug in question actually requires PA for this patient's specific plan, confirm the formulary tier, identify whether step therapy is required, locate the correct form or portal, and gather the clinical documentation the plan requires.

For practices with Medicaid patients enrolled across multiple managed care plans, this means navigating a different portal, a different PDL, and a different PA criteria document for every MCO. In Michigan, a practice treating Medicaid patients may need to track coverage across 11 different MCO formularies. In New York, 7. Each plan updates its PDL on its own schedule, often without proactive notification to providers.

Formulary lookup is the first step in every PA workflow. If the drug is covered at the preferred tier without PA, there is no form to file, no hold time, no callback, no adverse event risk. The administrative cascade never starts.

What Changes When Lookup Is Instant

The structural problem with manual formulary lookup is not that it is difficult. It is that it takes time, and that time compounds. A single lookup across five MCOs in a state might take 20 minutes. For a practice doing 8 to 10 formulary checks per day, that is two to three hours of staff time — before a single PA form has been filed.

When formulary status is confirmed before the prescription is written — rather than after a claim rejects at the pharmacy — the entire subsequent workflow changes. PA requests are submitted with the correct documentation the first time. Claims do not reject. Patients do not leave the pharmacy empty-handed. Callbacks from the pharmacy team do not consume another 15 minutes per incident.

The AMA survey found that when asked what they would do with one extra hour per week, the most common answer from physicians was direct patient care. The second most common answer from clinical staff was the same. That is the opportunity cost that manual formulary lookup obscures — an hour spent navigating MCO portals is an hour not spent in the exam room.