The Health Wonk Shop: Prior Authorization in Health Insurance: A Needed Tool to Contain Costs or an Excessive Barrier to Needed Care?



Nearly 1 in 5 consumers with health insurance say their insurer delayed or denied care in the past year due to its requirements for prior authorization, a process through which insurers can require patients to obtain approval in advance before they will agree to cover specific services.

Insurers point to prior authorization as a tool to limit unnecessary and ineffective care, thereby reducing costs. However, the practice is also drawing increased scrutiny amid concerns that it creates unreasonable barriers to patients getting needed care and generates excessive paperwork burdens on doctors and other providers. Last month, federal regulators finalized new rules to govern how insurers use prior authorization in Medicare Advantage, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act’s federal Marketplace plans, while lawmakers are weighing potential broader legislation.

On February 22, a panel of four experts joined Larry Levitt, KFF’s executive vice president for health policy, for a 45-minute discussion addressing the future of prior authorization requirements in health care. The panel discussed why insurers use prior authorization, its impact on patients and providers, and how the new regulations may change current practices. They also examined the potential for further regulatory or legislative actions to address ongoing concerns.


  • Larry Levitt, Executive Vice President for Health Policy, KFF


  • Troyen Brennan, MD, Adjunct Professor of Health Policy and Management, Harvard T.H. Chan School of Public Health, and a former executive at CVS Caremark and Aetna
  • Fumiko Chino, MD, Radiation Oncologist, Memorial Sloan Kettering Cancer Center
  • Anna Schwamlein Howard, Principal, Policy Development, American Cancer Society Cancer Action Network
  • Kaye Pestaina, Vice President and Director of the Program on Patient and Consumer Protection, KFF

KFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights.

Subscribe and listen to the The Health Wonk Shop podcast through Apple Podcasts, Spotify, or wherever you get your podcasts.


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