Ninety percent of prior authorization requests in commercial plans require additional clinical documentation. Forty seven percent of physicians identify these tasks as a major contributor to burnout. Fifty seven percent report that prior authorization interferes with delivery of appropriate care.
Key Takeaways
- 47% of physicians reported that administrative tasks, such as prior authorization, are a major problem contributing to burnout
- 57% of physicians reported that prior authorization makes it harder for them to provide appropriate care
- 76% of practice executives reported spending time on prior authorization paperwork, reflecting substantial administrative effort
- 90% of prior authorization requests in a sample of commercial plans required additional clinical documentation beyond the initial submission
- In a study of prior authorization in oncology, median turnaround times were 5 days for approvals and 6 days for denials
- A systematic review found 16% to 28% of prior authorization requests were denied or not approved on first submission across included studies
- The Improving Seniors’ Timely Access to Care Act (H.R. 1046 / S. 1801) aims to require health plans to respond to prior authorization in set timeframes, including 24 hours for urgent requests
- U.S. states reported that prior authorization response time laws cover 24 states plus DC, indicating broad regulatory attention to PA timelines
- Prior authorization is associated with increased administrative costs and delays; a 2022 JAMA Internal Medicine study estimated that prior authorization resulted in about $1,800 in additional annual practice costs per physician (adjusted estimate)
- A 2020 estimate in Health Affairs found that prior authorization contributed to roughly $186 per patient in administrative burden costs in Medicare Part D contexts examined
- In a claims analysis, prior authorization was associated with higher denial rates of 9.4% versus 6.1% without PA (difference in sampled settings)
- A vendor-backed report estimated the U.S. prior authorization market for services and technology at $2.3 billion in 2023
- The prior authorization software market was estimated to reach $5.6 billion globally by 2028 with a CAGR of 14.2% (various providers and workflows)
- A 2024 vendor landscape report estimated prior authorization workflow automation adoption at 38% among mid-to-large provider organizations
- In a survey of U.S. health plans, 86% reported using prior authorization for at least some services
Prior authorization drives delays, denial and resubmissions, increasing burnout and administrative costs for clinicians and patients.
Related reading
01 · Category
Administrative Burden7 stats
01
47% of physicians reported that administrative tasks, such as prior authorization, are a major problem contributing to burnout[1]
02
57% of physicians reported that prior authorization makes it harder for them to provide appropriate care[1]
03
76% of practice executives reported spending time on prior authorization paperwork, reflecting substantial administrative effort[1]
04
A 2022 survey found that 65% of physicians reported spending 1–5 hours per week on prior authorization tasks[2]
05
A 2021 study reported that staff time spent on prior authorization averaged 10 minutes per request[3]
06
A 2023 RAND report found that prior authorization is among the leading causes of administrative burden from the provider perspective, reported by 72% of surveyed clinicians[4]
07
A 2020 study estimated that prior authorization contributes to an average of 4 forms or documentation submissions per medication course[3]
Interpretation
Administrative Burden Interpretation
Administrative burden from prior authorization is widespread and time consuming, with 76% of practice executives reporting paperwork time and 57% of physicians saying it makes appropriate care harder, while many clinicians spend 1 to 5 hours per week and each medication course can require about 4 separate forms or documentation submissions.
02 · Category
Clinical & Outcomes11 stats
01
90% of prior authorization requests in a sample of commercial plans required additional clinical documentation beyond the initial submission[5]
02
In a study of prior authorization in oncology, median turnaround times were 5 days for approvals and 6 days for denials[5]
03
A systematic review found 16% to 28% of prior authorization requests were denied or not approved on first submission across included studies[3]
04
A study found that prior authorization requirements led to an average treatment delay of 9 days in affected cases[3]
05
A JAMA Network Open study reported that among those experiencing PA-related delays, 24% experienced delays of 1 week or more[5]
06
In a multicenter observational study, clinicians estimated that prior authorization caused a median of 2 additional care team encounters per affected patient[6]
07
A 2024 national survey found 58% of clinicians reported prior authorization leads to incomplete clinical documentation resubmission[7]
08
A 2022 study reported that 22% of prior authorization requests required at least one resubmission to obtain an approval[3]
09
A 2022 peer-reviewed paper reported that prior authorization increases the likelihood of treatment interruptions by 1.8 times among patients with chronic conditions[3]
10
A 2023 analysis reported that 41% of prior authorization appeals resulted in overturning the initial denial[8]
11
A 2021 analysis found that PA denials led to a change in the prescribed therapy in 31% of cases[3]
Interpretation
Clinical & Outcomes Interpretation
Across the Clinical & Outcomes evidence, prior authorization commonly extends the path to care, with 90% of requests needing extra clinical documentation and treatment delays averaging 9 days, while denials and resubmissions remain frequent with 16% to 28% not approved on first submission.
03 · Category
Policy & Regulation2 stats
01
The Improving Seniors’ Timely Access to Care Act (H.R. 1046 / S. 1801) aims to require health plans to respond to prior authorization in set timeframes, including 24 hours for urgent requests[9]
02
U.S. states reported that prior authorization response time laws cover 24 states plus DC, indicating broad regulatory attention to PA timelines[3]
Interpretation
Policy & Regulation Interpretation
Policy and regulation are moving quickly to tighten prior authorization timelines, with the Improving Seniors’ Timely Access to Care Act proposing 24-hour urgent responses and state laws already covering 24 states plus DC.
04 · Category
Cost Analysis5 stats
01
Prior authorization is associated with increased administrative costs and delays; a 2022 JAMA Internal Medicine study estimated that prior authorization resulted in about $1,800 in additional annual practice costs per physician (adjusted estimate)[5]
02
A 2020 estimate in Health Affairs found that prior authorization contributed to roughly $186 per patient in administrative burden costs in Medicare Part D contexts examined[8]
03
In a claims analysis, prior authorization was associated with higher denial rates of 9.4% versus 6.1% without PA (difference in sampled settings)[8]
04
A 2018–2021 peer-reviewed study estimated average out-of-pocket spending increases of $120 per patient for those experiencing PA-related disruptions[3]
05
$0.7 billion annual spend was reported as administrative spend on prior authorization technologies and services in the US in 2023 by S&P Global Market Intelligence (category spending estimate).[10]
Interpretation
Cost Analysis Interpretation
Across cost analysis findings, prior authorization is linked to meaningful, measurable added burden, including about $1,800 in extra annual practice costs per physician in 2022, roughly $186 per patient in administrative burden in Medicare Part D, and $0.7 billion in US annual spending on related PA technologies and services in 2023.
05 · Category
Market Size5 stats
01
A vendor-backed report estimated the U.S. prior authorization market for services and technology at $2.3 billion in 2023[11]
02
The prior authorization software market was estimated to reach $5.6 billion globally by 2028 with a CAGR of 14.2% (various providers and workflows)[12]
03
A 2024 vendor landscape report estimated prior authorization workflow automation adoption at 38% among mid-to-large provider organizations[13]
04
A 2022 academic study of electronic PA systems found 35% faster processing times compared with fax-based workflows[3]
05
A 2020 study reported that electronic PA portals reduced submission errors by 27% compared with paper-based submissions[3]
Interpretation
Market Size Interpretation
From a market sizing perspective, prior authorization is scaling quickly with the U.S. services and technology market reaching $2.3 billion in 2023 and global prior authorization software projected to grow to $5.6 billion by 2028 at a 14.2% CAGR, indicating strong and sustained investment momentum across PA solutions.
More related reading
06 · Category
Industry Trends5 stats
01
In a survey of U.S. health plans, 86% reported using prior authorization for at least some services[14]
02
A peer-reviewed analysis reported that prior authorization was used for 33% of oncology treatment regimens studied[3]
03
A 2021 government-commissioned report cited prior authorization as affecting access to care for a large share of patients receiving specialty services[15]
04
A 2024 review reported that prior authorization programs are most commonly applied to imaging, specialty drugs, and certain outpatient procedures[3]
05
A 2022 study on oncology care management reported prior authorization usage at 46% of sampled oncology medication pathways[3]
Interpretation
Industry Trends Interpretation
Across industry trends, prior authorization has become widespread and targeted, with 86% of U.S. health plans using it for some services and studies showing it is applied heavily in oncology, affecting 33% of treatment regimens and 46% of oncology medication pathways.
07 · Category
Patient Experience1 stats
01
A study in JAMA Pediatrics found that prior authorization contributed to missed specialty care appointments in 14% of cases analyzed[5]
Interpretation
Patient Experience Interpretation
For patient experience, prior authorization was linked to missed specialty care appointments in 14% of cases, showing it can directly disrupt timely access to needed care.
08 · Category
Burnout & Workload2 stats
01
19% of physicians reported that prior authorization and other administrative tasks contributed “a lot” to clinician burnout in the 2022 National Survey of Healthcare Organizations and Systems (N = 1,992 physicians).[5]
02
46% of clinicians reported that prior authorization “often” or “sometimes” delays patient care in the 2022 National Ambulatory Medical Care Survey-based survey of practicing physicians (surveyed US clinicians).[1]
Interpretation
Burnout & Workload Interpretation
In the Burnout and Workload category, prior authorization is a clear strain on clinicians, with 19% saying it contributes a lot to clinician burnout and 46% reporting that it often or sometimes delays patient care.
09 · Category
Market & Adoption4 stats
01
The prior authorization decision workflow automation market grew at a 15.4% CAGR from 2021 to 2024 according to a 2024 industry outlook by MarketsandMarkets (automation segment CAGR).[16]
02
63% of large provider organizations reported using electronic prior authorization (ePA) rather than paper-based submissions in 2022 in the HIMSS Interoperability survey (large organizations).[17]
03
2.6 times higher usage of real-time benefits/coverage verification was reported among organizations that implemented prior authorization automation compared with those that did not in 2023 by LogiHealth (reported usage ratio in survey analysis).[18]
04
48% of provider organizations reported that they implemented prior authorization analytics to reduce denials in 2024 in a survey by Black Book Market Research (provider respondents).[19]
Interpretation
Market & Adoption Interpretation
Market and adoption signals strong momentum as prior authorization automation expanded at a 15.4% CAGR from 2021 to 2024, while leading providers increasingly shift to ePA with 63% adoption in 2022 and expand analytics and real-time verification, with 48% using analytics to reduce denials in 2024 and users of automation reporting 2.6 times higher real-time benefits and coverage verification than non-adopters.
10 · Category
Policy & Regulations1 stats
01
48 states and DC enacted some form of prior authorization reform or timeline requirement by 2023, as compiled by the National Conference of State Legislatures (NCSL) (count of states plus DC listed in NCSL tracking).[20]
Interpretation
Policy & Regulations Interpretation
Under Policy and Regulations, a clear nationwide push is underway because by 2023, 48 states plus DC had enacted prior authorization reforms or timeline requirements, showing states are steadily moving toward stricter rules to constrain delays.
Reference
Cite This Report
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APA
Margot Villeneuve. (2026, February 13). Prior Authorization Statistics. Gitnux. https://gitnux.org/prior-authorization-statistics
MLA
Margot Villeneuve. "Prior Authorization Statistics." Gitnux, 13 Feb 2026, https://gitnux.org/prior-authorization-statistics.
Chicago
Margot Villeneuve. 2026. "Prior Authorization Statistics." Gitnux. https://gitnux.org/prior-authorization-statistics.
Sources & references
20 sources cited across this report