Stuck in the System: How Prior Authorization Delays Frustrate and Harm Patients

DrFirst Survey Reveals Health Setbacks, Delays, and Frustrations from Prior Authorization Roadblocks

ROCKVILLE, Md., May 22, 2025 – Specialty medications hold the promise of life-changing treatments, but access to these expensive therapies can be anything but smooth. Roadblocks along the medication journey, including those related to the prior authorization (PA) process, can cause frustration, treatment delays, and health setbacks, according to a recent DrFirst survey.

The survey of 1,000 U.S. consumers who have experienced PAs offers insight into how the process impacts their ability to receive timely access to care. The survey reveals how often patients must take extra steps—such as tests, calls, and scans—and endure weeks-long waits for approval, often leading to delays or denials of provider-recommended therapy.

“Prior authorization often feels like a black box to patients, creating uncertainty and delaying essential care,” said Colin Banas, M.D., M.H.A., chief medical officer for DrFirst. “Even simple requests for information, such as additional documentation or medication history, can lead to serious delays which heighten patient anxiety and hinder adherence.”

Survey Key Findings

Patient Frustrations

More than half of Americans (58%) who’ve needed to get PAs for prescribed medications say it’s been challenging, with 13% describing the process as “very difficult.”

Additionally, over a third (36%) said their health condition worsened while waiting for their PA to be approved.

Over half of Americans who’ve needed to get PA (58%) found the PA experience challenging, including:

• Mildly frustrating (41%)
• Extremely stressful (17%)

Extra Steps for Patients on the Front End

Many patients said they were required to take extra steps before the prior authorization was submitted for approval, including:

• Contacting their prescribing physician (52%)
• Having an additional appointment with their prescribing physician (29%)
• Seeing a specialist (25%)
• Trying a different medication first (24%)
• Additional blood tests (20%)
• Additional diagnostics, such as an MRI or CT scan (19%)

Patients who were required to try a less expensive medication as part of the prior authorization process reported mixed results. Nearly half of patients who had to try a less expensive medication first—a policy known as “step therapy” or “fail first”—said the lower-cost medication did not work well for them (42%).

Waiting Can Feel Like Forever

Regardless of whether their PA was approved or denied, more than a quarter of patients (27%) waited from two weeks to over a month for a decision, reporting wait times of:

• 2-3 weeks (16%)

• About a month (5%)
• Over a month (6%)

Some Are Left Wondering

Over a third of patients (36%) reported having at least one denial for a PA. Five percent, however, said they never heard one way or the other.

Those who were notified of their PA decision learned the news from their:

• Doctor (45%)
• Pharmacy (35%)
• Insurer (16%)

After a PA Denial

After experiencing a PA denial, patients’ experiences ranged from successful appeals to giving up treatment entirely. Patients reported:

• Contacting their prescribing doctor to discuss options (41%)
• Eventually getting the PA approved after their doctor appealed the decision (31%)
• Using another medication first, as required by their insurer (28%)
• Paid for the medication without using insurance (23%)
• Used a drug discount card or coupon to afford the medication (22%)
• Got the medication from an online direct-to-consumer healthcare service, such as LillyDirect, hims & hers, or BetterHelp (18%)
• Did not take the prescribed medication (9%)

Improving the Patient Experience

Patients shouldn’t have to wonder about their prior authorization status or next steps. Additionally, healthcare providers should have AI, automation, and other tools they can use within their prescribing workflow to meet prior authorization requirements as quickly as possible, with some being resolved immediately so there is no delay or back and forth.

With the recent advances in AI, most patients (58%) said they trust AI to help their healthcare providers with prior authorizations. Patients recognized several benefits, including:

• Giving healthcare providers more time to help patients (37%)
• Patients can start needed therapy more quickly (22%)
• AI can catch human error that could delay PA approvals (21%)
• Patients experience less frustration and worry (20%)

DrFirst is leading the way in prior authorization and collaborating with other innovation partners across the medication journey to speed access to life-saving treatments. Addressing PA pain points for diverse stakeholders—patients, providers, and payers—means patients receive timely care with fewer obstacles.

“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 Banas. “Every day saved is a win for patients who are fighting for their lives.”

About DrFirst

For 25 years, healthcare IT pioneer DrFirst has empowered providers and patients to achieve better health through intelligent medication management. We improve healthcare workflows and help patients start and stay on therapy with end-to-end solutions that enhance prescription access, affordability, and adherence. DrFirst has recently won over 25 awards for excellence and innovation, including winning Gold in the prestigious Edison Awards in 2023, recognizing our game-changing use of clinical-grade AI to streamline time-consuming healthcare workflows and prevent medication errors. Our solutions help 100 million patients a year and are used by more than 450,000 prescribers, 71,000 pharmacies, 270 EHRs and health information systems, and over 2,000 hospitals in the U.S. To learn more, visit DrFirst.com and follow @DrFirst. 

Media Contact:
Erin Jundef
Bospar for DrFirst
ejundef@bospar.com