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  1. Home
  2. State Restrictions On Prior Authorization.
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  2. State Restrictions On Prior Authorization.

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State restrictions on prior authorization.

David H Howard1, Alissa Durakovic

  • 1Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322.

The American Journal of Managed Care
|September 18, 2025

View abstract on PubMed

Summary
This summary is machine-generated.

State laws restricting insurer prior authorization may increase healthcare costs. These regulations, while intended to help patients, could lead to unintended negative outcomes and financial burdens.

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Area of Science:

  • Health policy research
  • Economics of healthcare

Background:

  • Insurers use prior authorization (PA) to control healthcare costs.
  • Many states are implementing laws to limit PA requirements.

Purpose of the Study:

  • To analyze the potential economic impacts of state-level prior authorization restrictions.

Main Methods:

  • Review of state legislation concerning prior authorization.
  • Economic modeling of potential cost shifts.

Main Results:

  • Legislation limiting prior authorization may increase overall healthcare expenditures.
  • Potential for increased administrative burden and costs for providers and payers.

Conclusions:

  • State-specific prior authorization laws may have significant, potentially negative, financial consequences.
  • Careful consideration of economic implications is needed when enacting such policies.