The thick fog of prior authorization—where prescriptions get lost in administrative limbo—is poised to dissipate. Regulatory mandates, maturing technology, and shifting patient expectations are poised to transform the way medication access is handled in 2026 and beyond.
While the specialty pharmaceuticals market increased a staggering 40% from 2023 to 2024, it shows no signs of slowing down. With specialty drugs now accounting for about 75% of the approximately 7,000 new drugs under development, the market is expected to approach $1 trillion by 2023.
Yet these life-changing therapies remain frustratingly difficult for providers to prescribe and patients to access. Our Chief Medical Officer Colin Banas, M.D., M.H.A., captured this reality in conversations with other industry leaders throughout 2025: “The doctor who writes the prescription often doesn’t know if a prior authorization is required, what information the payer needs, or the status of the request,” he said.
“The fact that specialty medications are split into two administrative silos comes as a shock to most people. You have the pharmacy benefit on one side and the medical benefit on the other, and they operate with completely different rules for prior authorizations,” Dr. Banas said in an interview in Pharmashots.
This division reinforces the problems of duplicate workflows, separate approval processes, and dedicated staff for manual PA management. To overcome medication access barriers, future solutions must bridge this divide, presenting unified benefit information regardless of coverage silo.
“There are armies of people sitting at desks doing this in a very manual fashion right now … which is ridiculous,” he said on the American Journal of Healthcare Strategy podcast. Nurses, physician associates, and medical assistants could be “taking care of patients or quality initiatives.”
The past year saw a key shift toward AI built for specific workflow pain points, not vague automation promises. Imagine predictive tools that anticipate approvals or automated decision support that flags PA needs before prescribing.
“Whether it’s automating prior authorization workflows, integrating predictive analytics for medication adherence, or enabling chat-driven clinical decision support, the focus should be on reducing administrative burden and improving patient outcomes,” Dr. Banas told Healthcare IT News. “Look for AI systems that provide real, quantifiable value to clinicians and patients alike.”
Specialty medication use will keep growing, particularly as GLP-1 drugs gain FDA approval for more than diabetes and obesity. Each new indication adds more specialty prescriptions, exposing system inefficiencies.
As Dr. Banas notes on Managed Care Cast: “You have much more visibility into your pizza order on your phone than you do to the status and location of a life-saving medication that’s going through a prior authorization.”
In early 2025, DrFirst surveyed 1,000 U.S. patients with medications requiring prior authorizations and the findings were clear:
“While prior authorizations are here to stay, we can simplify the process by embracing AI and automation and improving payer-provider collaboration, giving patients and providers back valuable time,” said Dr. Banas. “Every day saved is a win for patients who are fighting for their lives.”
The future of PA will look quite different than today by solving access problems before they start. Here’s what the industry is heading toward:
The transition won’t happen overnight. Payers will need to modernize legacy systems, some of which still rely on fax-based communications.
The regulatory timeline will serve as an incentive, but early adopters will gain competitive and other advantages, similar to the first users of electronic health records.
“Technology can remove barriers that stand between a clinical decision and a patient’s ability to start and stay on their medications,” Dr. Banas said in an HIT Leaders article about fixing the medication journey.
“Every good revolution in healthcare starts with a good framework,” Dr. Banas told Pharmaceutical Commerce. “We’re laying the rails now to get the train moving.”