AI’s Ascent in Electronic Prior Authorization: From Hesitation to Integration

AI is making waves in healthcare, but not without some challenges. Building confidence in AI outputs is one of them. According to recently released AMA augmented intelligence research, 82% of physicians want AI solutions to be backed by evidence of safety and effectiveness, with ongoing oversight to support confidence in the results. In addition, 88% expressed the need for a “designated channel for feedback” should questions about the validity of AI outputs arise. Despite these concerns, however, physicians’ use of AI in medical practice gained significant ground—climbing from 38% to 66% in the past year.

With AI adoption on the fast track, the conversation is shifting from “if” AI will play a role in healthcare to “how” it should be implemented—especially in areas like electronic prior authorization (ePA).

Balancing the Use of AI for Optimal Impact 

AI can reduce process inefficiencies but accuracy, bias, and security concerns still linger. That’s why many have begun referring to AI as augmented intelligence, maintaining that it should enhance—not replace—human decision-making.

For physicians, this distinction matters. Nearly six in 10 see opportunities for AI to address administrative burdens through automation. Top use cases mentioned include taking over repetitive tasks like summarizing visit notes, retrieving insurance requirements, and organizing prior authorization requests so doctors can focus on diagnosing, treating, and caring for patients—the work they trained for.

To truly support clinicians, AI needs safeguards to prevent unintended consequences: 

• Robust security measures to protect patient information and ensure compliance with privacy regulations. 

• Alerts to flag AI uncertainty, allowing for human oversight in the moment. 

• Routine audits to help detect and correct bias or hallucinations in AI outputs. 

With these safeguards, AI becomes a true partner—increasing workflow efficiency and maintaining clinical integrity.  

The AMA augmented intelligence research also notes that 86% of physicians want to be responsible for or consulted before AI tools are implemented in their practice. This input is critical—not only for trust but also for ensuring AI solutions align with real-world clinical needs. 

How AI Supports Electronic Prior Authorization for Specialty Medications and More 

Prior authorizations are a known bottleneck in healthcare. They require extensive paperwork and back-and-forth communication between healthcare providers (HCPs) and payers, which results in patient care delays and paperwork overload.

The need to ease the burden of ePAs is even more pressing as specialty medications become more common. While representing only 6% of prescription volume, these high-cost therapies account for 71% of drug spending, making them significantly more likely to require ePA and have more complicated approval processes. Unlike traditional medications, specialty drugs may be covered under the pharmacy benefit, the medical benefit, or both—adding to HCPs’ workloads.

Without efficient systems, navigating these requirements can slow patients’ access to vital therapies. However, large language models (LLMs) and machine learning can analyze vast amounts of data, interpret insurance policies, and standardize information to the time physicians spend on ePA submissions.

Here’s how AI improves ePA for HCPs:

• Turning chaos into clarity: AI can organize unstructured data into a structured, easy-to-use format, reducing administrative burden.

• Automating manual tasks: AI can handle repetitive data entry so clinicians and staff can focus on patient care.

• Improving approval times: Intelligent automation helps avoid preventable denials by minimizing typos, missing information, or inconsistencies in PA submissions, leading to faster approvals and better patient outcomes.

While AI won’t replace physicians, its role in healthcare is no longer a question. The real opportunity lies in using it to give physicians something invaluable—more time to focus on providing the best patient care possible.

Electronic prior authorization is just one piece of the end-to-end medication management puzzle. DrFirst optimizes workflows at every step—from prescribing to adherence—and using AI increasingly makes these processes more efficient.

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