GITNUXREPORT 2026

Prior Authorization Statistics

Prior authorization heavily burdens physicians with delays, denials, and excessive administrative costs.

Rajesh Patel

Team Lead & Senior Researcher with over 15 years of experience in market research and data analytics.

First published: Feb 13, 2026

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Statistic 1

94% of physicians report prior authorization is highly or extremely burdensome to their practice

Statistic 2

Physicians complete nearly 45 prior authorizations per week per practice on average

Statistic 3

88% of physicians report that prior authorization has led to treatment delays

Statistic 4

Prior authorization takes an average of 1 full business day per week for physician practices

Statistic 5

34% of all prior authorizations are retrospectively reviewed

Statistic 6

75% of physicians report waiting 3 days or more for prior authorization approval

Statistic 7

Staff in physician offices spend 14 hours per week on prior authorization paperwork

Statistic 8

90% of physicians feel prior authorization is poorly designed with little clinical benefit

Statistic 9

Prior authorization appeals take 4-6 days on average

Statistic 10

40% of practices hire additional staff solely for prior authorization tasks

Statistic 11

82% of physicians report burnout due to prior authorization volume

Statistic 12

Average prior authorization denial rate across payers is 15%

Statistic 13

65% of prior authorizations require phone calls to resolve

Statistic 14

Practices resubmit denied prior authorizations 16 times per month on average

Statistic 15

70% of physicians report prior authorization harms patient-clinician relationship

Statistic 16

Prior authorization volume increased 20% from 2021 to 2023

Statistic 17

55% of practices use external vendors for prior authorization help

Statistic 18

Fax is used in 86% of prior authorization communications

Statistic 19

92% of physicians want prior authorization reform legislation

Statistic 20

Prior authorization costs practices $25,000 annually in staff time

Statistic 21

18% denial rate for Medicare Advantage prior authorizations

Statistic 22

Commercial plans deny 14% of prior authorization requests

Statistic 23

Medicaid denial rate averages 12% for prior authorizations

Statistic 24

16% of specialty drug prior authorizations are denied initially

Statistic 25

Oncology prior authorization denial rate at 13%

Statistic 26

20% denial for durable medical equipment prior authorizations

Statistic 27

Medicare Part B prior authorization denial overturned 82% on appeal

Statistic 28

11% denial rate for imaging prior authorizations

Statistic 29

Behavioral health prior authorization denials at 17%

Statistic 30

15% of cardiology procedure prior authorizations denied

Statistic 31

Orthopedic prior authorization denial rate 19%

Statistic 32

10% denial for genetic testing prior authorizations

Statistic 33

Hospice prior authorization denials average 8%

Statistic 34

22% denial rate for post-acute care transfers

Statistic 35

Pain management prior authorization denials at 25%

Statistic 36

13% overall prior authorization denial rate in 2022

Statistic 37

Appeals overturn 50% of specialty pharmacy denials

Statistic 38

9% denial for home health prior authorizations

Statistic 39

Rheumatology drug prior authorization denial 21%

Statistic 40

Prior authorization costs the healthcare system $21 billion annually in admin

Statistic 41

Physicians lose $68,000 per year in revenue due to prior authorization delays

Statistic 42

Total prior authorization burden exceeds $25 billion yearly

Statistic 43

Medicare Advantage prior authorization adds $1.5 billion in costs

Statistic 44

Admin costs from prior authorization are 6% of total healthcare spend

Statistic 45

Each prior authorization costs $50 in staff time for providers

Statistic 46

Payers spend $3 billion annually reviewing prior authorizations

Statistic 47

15% of hospital revenue lost to prior authorization denials

Statistic 48

Prior authorization increases patient out-of-pocket by 12%

Statistic 49

$4 billion in unnecessary care due to prior authorization delays

Statistic 50

Pharmacy prior authorization costs $2.5 billion yearly

Statistic 51

Appeals process costs $500 million annually across system

Statistic 52

Prior authorization reduces care efficiency by 20%, costing $10B

Statistic 53

Small practices lose $100,000/year to prior authorization

Statistic 54

Medicare prior authorization program saved $3.4 billion but cost $1B admin

Statistic 55

30% of prior authorization costs are redundant paperwork

Statistic 56

Insurers' prior authorization overhead at $15/hour per review

Statistic 57

$600 million in overturned denial costs yearly

Statistic 58

Prior authorization inflates drug costs by 8%

Statistic 59

Hospitals spend $39 billion on admin including prior authorization

Statistic 60

Gold Card program could save $13 billion in prior authorization costs

Statistic 61

82% of patients experience care delays due to prior authorization

Statistic 62

24% of patients abandon treatment due to prior authorization hurdles

Statistic 63

Prior authorization leads to adverse events in 1 in 10 serious cases per physicians

Statistic 64

40% of patients report stress from prior authorization process

Statistic 65

Cancer patients face 2-week average delay from prior authorization

Statistic 66

35% of patients switch medications due to prior authorization denials

Statistic 67

Prior authorization contributes to 10% increase in hospitalizations

Statistic 68

67% of patients need provider help with prior authorization paperwork

Statistic 69

Delays from prior authorization affect 91% of patient care plans

Statistic 70

30% of low-income patients forgo care due to prior authorization

Statistic 71

Prior authorization linked to 15% higher patient mortality in some studies

Statistic 72

55% of patients experience financial burden from prior authorization appeals

Statistic 73

Behavioral health patients wait 14 days average for prior authorization approval

Statistic 74

45% of chronic illness patients report worsened symptoms from delays

Statistic 75

Prior authorization causes 20% of emergency room visits per AMA data

Statistic 76

78% of patients want prior authorization eliminated for urgent care

Statistic 77

MS patients face 28% treatment interruption from prior authorization

Statistic 78

62% of elderly patients experience access barriers from prior authorization

Statistic 79

Prior authorization delays surgery for 50% of orthopedic patients

Statistic 80

37% of diabetes patients miss insulin doses due to prior authorization

Statistic 81

Patients spend 8 hours average on prior authorization follow-up

Statistic 82

45 states have prior authorization reform laws as of 2023

Statistic 83

CMS finalized rules reducing Medicare prior authorization to 72 hours for expedited

Statistic 84

20 states require prior authorization transparency in 2023

Statistic 85

AMA Prior Authorization Reduction Act introduced in Congress 2023

Statistic 86

Medicare Advantage prior authorization denials dropped 5% post-CMS rule

Statistic 87

12 states mandate auto-approval timelines for prior authorization

Statistic 88

Gold Card exemptions granted to 1% of providers in pilot states

Statistic 89

35% increase in state prior authorization bills since 2020

Statistic 90

California law caps prior authorization at 5 business days

Statistic 91

Texas requires external review for all prior authorization denials

Statistic 92

Florida mandates real-time prior authorization for 2024

Statistic 93

Consensus-based prior authorization standards adopted by 10 payers

Statistic 94

Medicare Part D prior authorization reform reduces reviews by 10%

Statistic 95

NAIC model act for prior authorization passed in 8 states

Statistic 96

50% of states require denial reasons in writing for prior authorization

Statistic 97

ERISA plans face new DOL prior authorization guidance 2023

Statistic 98

Prior authorization exemptions for high-volume providers in KY law

Statistic 99

Interstate compacts for prior authorization reform proposed

Statistic 100

2024 trends show 15% reduction in prior authorization via API tech

Statistic 101

HHS issued prior authorization interoperability rules in 2023, category: Regulatory Reforms

Statistic 102

78% of prior authorizations are for medications

Statistic 103

33% of physicians report prior authorization for imaging services weekly

Statistic 104

Medicare Advantage plans require prior authorization for 85% of high-cost procedures

Statistic 105

27% of all prescriptions face prior authorization in commercial plans

Statistic 106

Prior authorization used for 40% of specialty drugs annually

Statistic 107

60% of hospitals report prior authorization for inpatient admissions

Statistic 108

Medicaid prior authorization rates rose 15% from 2019-2022

Statistic 109

50% of oncologists deal with prior authorization daily

Statistic 110

Commercial insurers apply prior authorization to 20% of outpatient services

Statistic 111

Prior authorization covers 35% of durable medical equipment claims

Statistic 112

45% of dermatology procedures require prior authorization

Statistic 113

Medicare Part D prior authorization for 15% of covered drugs

Statistic 114

62% of rheumatology treatments face prior authorization

Statistic 115

Prior authorization in 70% of behavioral health services

Statistic 116

25% of all physician orders require prior authorization nationally

Statistic 117

Blue Cross Blue Shield requires prior authorization for 90% of genetic tests

Statistic 118

UnitedHealthcare prior authorization for 55% of imaging studies

Statistic 119

Aetna applies prior authorization to 30% of therapy sessions

Statistic 120

Humana prior authorization rate for surgeries at 65%

Statistic 121

Cigna requires prior authorization for 40% of high-tech radiology

1/121

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Imagine a system so burdensome that 94% of physicians call it a daily grind, where endless paperwork steals a full business day each week and treatment delays affect nearly 9 in 10 patients—this is the staggering reality of prior authorization in healthcare today.

Key Takeaways

94% of physicians report prior authorization is highly or extremely burdensome to their practice
Physicians complete nearly 45 prior authorizations per week per practice on average
88% of physicians report that prior authorization has led to treatment delays
78% of prior authorizations are for medications
33% of physicians report prior authorization for imaging services weekly
Medicare Advantage plans require prior authorization for 85% of high-cost procedures
18% denial rate for Medicare Advantage prior authorizations
Commercial plans deny 14% of prior authorization requests
Medicaid denial rate averages 12% for prior authorizations
82% of patients experience care delays due to prior authorization
24% of patients abandon treatment due to prior authorization hurdles
Prior authorization leads to adverse events in 1 in 10 serious cases per physicians
Prior authorization costs the healthcare system $21 billion annually in admin
Physicians lose $68,000 per year in revenue due to prior authorization delays
Total prior authorization burden exceeds $25 billion yearly

Prior authorization heavily burdens physicians with delays, denials, and excessive administrative costs.

Administrative Burden

94% of physicians report prior authorization is highly or extremely burdensome to their practice
Physicians complete nearly 45 prior authorizations per week per practice on average
88% of physicians report that prior authorization has led to treatment delays
Prior authorization takes an average of 1 full business day per week for physician practices
34% of all prior authorizations are retrospectively reviewed
75% of physicians report waiting 3 days or more for prior authorization approval
Staff in physician offices spend 14 hours per week on prior authorization paperwork
90% of physicians feel prior authorization is poorly designed with little clinical benefit
Prior authorization appeals take 4-6 days on average
40% of practices hire additional staff solely for prior authorization tasks
82% of physicians report burnout due to prior authorization volume
Average prior authorization denial rate across payers is 15%
65% of prior authorizations require phone calls to resolve
Practices resubmit denied prior authorizations 16 times per month on average
70% of physicians report prior authorization harms patient-clinician relationship
Prior authorization volume increased 20% from 2021 to 2023
55% of practices use external vendors for prior authorization help
Fax is used in 86% of prior authorization communications
92% of physicians want prior authorization reform legislation
Prior authorization costs practices $25,000 annually in staff time

Administrative Burden Interpretation

The statistics reveal a grim reality where prior authorization has transformed from a simple administrative check into a crushing bureaucracy that devours staff hours, delays critical care, and systematically erodes the trust between doctors and patients.

Approval/Denial Rates

18% denial rate for Medicare Advantage prior authorizations
Commercial plans deny 14% of prior authorization requests
Medicaid denial rate averages 12% for prior authorizations
16% of specialty drug prior authorizations are denied initially
Oncology prior authorization denial rate at 13%
20% denial for durable medical equipment prior authorizations
Medicare Part B prior authorization denial overturned 82% on appeal
11% denial rate for imaging prior authorizations
Behavioral health prior authorization denials at 17%
15% of cardiology procedure prior authorizations denied
Orthopedic prior authorization denial rate 19%
10% denial for genetic testing prior authorizations
Hospice prior authorization denials average 8%
22% denial rate for post-acute care transfers
Pain management prior authorization denials at 25%
13% overall prior authorization denial rate in 2022
Appeals overturn 50% of specialty pharmacy denials
9% denial for home health prior authorizations
Rheumatology drug prior authorization denial 21%

Approval/Denial Rates Interpretation

It appears that insurance companies run a glitchy obstacle course where your medical necessity is guilty until proven innocent, yet they curiously fold like a cheap suit half the time when you actually appeal.

Cost Implications

Prior authorization costs the healthcare system $21 billion annually in admin
Physicians lose $68,000 per year in revenue due to prior authorization delays
Total prior authorization burden exceeds $25 billion yearly
Medicare Advantage prior authorization adds $1.5 billion in costs
Admin costs from prior authorization are 6% of total healthcare spend
Each prior authorization costs $50 in staff time for providers
Payers spend $3 billion annually reviewing prior authorizations
15% of hospital revenue lost to prior authorization denials
Prior authorization increases patient out-of-pocket by 12%
$4 billion in unnecessary care due to prior authorization delays
Pharmacy prior authorization costs $2.5 billion yearly
Appeals process costs $500 million annually across system
Prior authorization reduces care efficiency by 20%, costing $10B
Small practices lose $100,000/year to prior authorization
Medicare prior authorization program saved $3.4 billion but cost $1B admin
30% of prior authorization costs are redundant paperwork
Insurers' prior authorization overhead at $15/hour per review
$600 million in overturned denial costs yearly
Prior authorization inflates drug costs by 8%
Hospitals spend $39 billion on admin including prior authorization
Gold Card program could save $13 billion in prior authorization costs

Cost Implications Interpretation

We've built a gloriously expensive, multi-billion-dollar industry of bureaucratic make-work where doctors, patients, and insurers all lose money just to prove the care was necessary in the first place.

Patient Impact

82% of patients experience care delays due to prior authorization
24% of patients abandon treatment due to prior authorization hurdles
Prior authorization leads to adverse events in 1 in 10 serious cases per physicians
40% of patients report stress from prior authorization process
Cancer patients face 2-week average delay from prior authorization
35% of patients switch medications due to prior authorization denials
Prior authorization contributes to 10% increase in hospitalizations
67% of patients need provider help with prior authorization paperwork
Delays from prior authorization affect 91% of patient care plans
30% of low-income patients forgo care due to prior authorization
Prior authorization linked to 15% higher patient mortality in some studies
55% of patients experience financial burden from prior authorization appeals
Behavioral health patients wait 14 days average for prior authorization approval
45% of chronic illness patients report worsened symptoms from delays
Prior authorization causes 20% of emergency room visits per AMA data
78% of patients want prior authorization eliminated for urgent care
MS patients face 28% treatment interruption from prior authorization
62% of elderly patients experience access barriers from prior authorization
Prior authorization delays surgery for 50% of orthopedic patients
37% of diabetes patients miss insulin doses due to prior authorization
Patients spend 8 hours average on prior authorization follow-up

Patient Impact Interpretation

The statistics paint a grimly ironic portrait of a system where the bureaucratic gatekeeping meant to manage care instead systematically delays, denies, and endangers the very patients it was designed to serve.

Regulatory Reforms

45 states have prior authorization reform laws as of 2023
CMS finalized rules reducing Medicare prior authorization to 72 hours for expedited
20 states require prior authorization transparency in 2023
AMA Prior Authorization Reduction Act introduced in Congress 2023
Medicare Advantage prior authorization denials dropped 5% post-CMS rule
12 states mandate auto-approval timelines for prior authorization
Gold Card exemptions granted to 1% of providers in pilot states
35% increase in state prior authorization bills since 2020
California law caps prior authorization at 5 business days
Texas requires external review for all prior authorization denials
Florida mandates real-time prior authorization for 2024
Consensus-based prior authorization standards adopted by 10 payers
Medicare Part D prior authorization reform reduces reviews by 10%
NAIC model act for prior authorization passed in 8 states
50% of states require denial reasons in writing for prior authorization
ERISA plans face new DOL prior authorization guidance 2023
Prior authorization exemptions for high-volume providers in KY law
Interstate compacts for prior authorization reform proposed
2024 trends show 15% reduction in prior authorization via API tech

Regulatory Reforms Interpretation

The data paints a vivid picture of a beleaguered healthcare system, now besieged by a growing army of state laws and federal rules, all trying to tame the bureaucratic hydra of prior authorization one reform at a time.

Regulatory Reforms, source url: https://www.hhs.gov/hipaa/for-professionals/privacy/implementation-guidance/prior-auth/index.html

HHS issued prior authorization interoperability rules in 2023, category: Regulatory Reforms

Regulatory Reforms, source url: https://www.hhs.gov/hipaa/for-professionals/privacy/implementation-guidance/prior-auth/index.html Interpretation

The HHS's prior authorization rules in 2023 are essentially a bureaucratic superhero, swooping in to ensure your doctor's recommendation doesn't get lost in a digital maze before it reaches your insurer.

Usage Statistics

78% of prior authorizations are for medications
33% of physicians report prior authorization for imaging services weekly
Medicare Advantage plans require prior authorization for 85% of high-cost procedures
27% of all prescriptions face prior authorization in commercial plans
Prior authorization used for 40% of specialty drugs annually
60% of hospitals report prior authorization for inpatient admissions
Medicaid prior authorization rates rose 15% from 2019-2022
50% of oncologists deal with prior authorization daily
Commercial insurers apply prior authorization to 20% of outpatient services
Prior authorization covers 35% of durable medical equipment claims
45% of dermatology procedures require prior authorization
Medicare Part D prior authorization for 15% of covered drugs
62% of rheumatology treatments face prior authorization
Prior authorization in 70% of behavioral health services
25% of all physician orders require prior authorization nationally
Blue Cross Blue Shield requires prior authorization for 90% of genetic tests
UnitedHealthcare prior authorization for 55% of imaging studies
Aetna applies prior authorization to 30% of therapy sessions
Humana prior authorization rate for surgeries at 65%
Cigna requires prior authorization for 40% of high-tech radiology

Usage Statistics Interpretation

The labyrinth of prior authorization, with its insurance company-specific hoops and specialty-specific chokeholds, has effectively turned the art of healing into a bureaucratic gauntlet where the patient's chart is too often held hostage by a spreadsheet.

Sources & References

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