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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
Summary
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.
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.
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