Top Challenges of 2022, No. 3: Prior Authorizations

Doctors want to treat patients using the care they were trained to give but often find themselves arguing with someone from an insurance company about what the best course of treatment is. This is the main reason physicians consistently rank third-party interference as one of their biggest challenges.

“The problem with a lot of insurance companies is they change what’s on their formularies, and one day the insulin NovoLog is covered and then next day it changes to Humalog, and now the patient has to switch and it’s very confusing. And if you want to keep them on the same one, you have to put in the prior authorization, and the insurance company wants them to try the other one first,” says Richard Bryce, D.O., a family medicine physician and chief medical officer for the Community Health and Social Services Center in Detroit.