Prior Authorization Delays Linked to Worsened Outcomes in Neurological Diseases, Study Finds
核心洞察
Prior authorization requirements can delay care and worsen health conditions for patients with neurological diseases such as epilepsy (搜索) and Parkinson's disease (搜索), according to a JAMA Neurology study.
Nearly half of insured adults report having care denied or delayed due to prior authorization requirements, per a KFF survey.
Starting in 2027, certain health insurers will be required to implement electronic prior authorization submission systems to speed up the process.
Prior authorization requirements imposed by health insurance companies are increasingly delaying patient care and worsening outcomes for individuals with neurological conditions, according to research published in JAMA Neurology. The study found that prior authorization is "particularly concerning in neurology, where timely treatment is critical to avoid disease progression and optimize patient outcomes."
The findings highlight a growing tension between insurers' cost-containment strategies and clinicians' ability to deliver timely, evidence-based care. Health insurance plans are increasingly using prior authorization to determine what medical care patients receive, a process that requires healthcare providers to obtain approval before a specific drug, procedure, or medical test will be covered.
Scope of the Problem
According to a survey by health research group KFF, nearly half of insured adults say they have had care denied or delayed or had to take medications other than the ones their doctor initially prescribed because of prior authorization requirements. The burden extends to physicians as well: an American Medical Association survey found that doctors now juggle an average of 43 prior authorization requests per week, spending more than 15 hours weekly on these administrative tasks.
"Surveys of doctors found they're spending 15-plus hours a week, on average, just fighting these prior authorization battles for their patients," said Kevin Brasler, executive editor of Washington Consumers' Checkbook.
Impact on Neurological Care
For patients with neurological conditions, the consequences of delayed authorization can be severe. The JAMA Neurology study specifically identified that prior authorization can delay care and worsen health conditions for people with diseases such as epilepsy (搜索) and Parkinson's disease (搜索).
Sarah M. Benish, MD, FAAN, professor and vice chair of clinical affairs at the University of Minnesota, noted that the most common reason for denial of a treatment for a neurological condition is that the insurer wants the doctor to prescribe a less expensive or alternate option first—a practice known as step therapy.
Patient experiences underscore the clinical stakes. One patient with relapsing-remitting multiple sclerosis (搜索) described waiting a full year for appeals to succeed after her insurer repeatedly required her to first try a medication to which she had developed an allergy. "I wasn't on any treatment while I waited," she said.
Regulatory and Industry Response
Health groups, including the American Academy of Neurology (搜索), have been advocating for changes to prior authorization for years. Starting in 2027, certain health insurers and health plans—including those offering coverage through the ACA Marketplace, Medicaid, CHIP, and Medicare Advantage plans—will be required to implement a system that allows electronic submission of prior authorization requests.
Additionally, major health insurers including Aetna, Cigna, and the Blue Cross Association have pledged to the U.S. Department of Health and Human Services to standardize documentation processes and reduce the time required for prior authorization decisions. These insurers are also removing prior authorization requirements for certain services, such as allowing a 90-day grace period for some previously approved treatments and prescriptions when a patient changes insurers.
"These and other proposed changes will ultimately make the process more efficient, which could get medicines into the hands of our patients faster," said Tyler J. Allison, MD, FAAN, program director for the Children's Mercy Child Neurology residency program in Kansas City.
The Appeals Landscape
Despite the frustrations, data suggest that patients who pursue appeals have a strong chance of success. According to the AMA, more than 83% of appeals resulted in an insurance company partially or fully overturning the initial denial in 2022. However, a Kaiser Family Foundation analysis of Medicare Advantage data from 2019 to 2022 found that fewer than 1 in 10 denied requests are appealed.
In September 2025, lawmakers proposed the Safe Step Act to put limits on step therapy. If passed, the bill could give patients and doctors a clear, quick way to bypass step therapy in some cases, allowing patients to receive their medications sooner.
Navigating the System
Experts recommend that patients take proactive steps when facing prior authorization hurdles. Jonathan R. Crowe, MD, MPH, MSc, assistant professor of neurology and public health sciences at the University of Virginia, emphasized that incorrect information in patient records can slow down authorization and appeals. Patients are advised to contact their doctor's office immediately upon learning of a prior authorization requirement, keep personal and insurance information current, and follow up with insurers regularly.
For patients facing denials, alternative pathways include manufacturer financial assistance programs, pharmacy discount services such as GoodRx or SingleCare, clinical trial enrollment, and physician-provided drug samples as temporary bridging options.