Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation

Prior authorization (PA), a practice used by health insurance companies in the US to control care utilization, may create barriers for treatment delivery. Less is known regarding its impact on delaying and denying prescription medication dispensing.

To examine PA processing times and approval rates for branded medication prescriptions that are initially rejected, and to assess key factors associated with variations in these outcomes.

This cross-sectional study used 2024 IQVIA pharmacy claims data to identify branded drug dispensations that faced initial PA rejections and completed the PA adjudication process. The frequencies of same-day processed PA reviews and the final approval rates were calculated. They were then stratified by number of PA reviews, additional rejection reasons, refill status, days of supply, prescribers' ownership, insurance market segment, and patient characteristics. Logistic regressions were performed to estimate the association between these factors and the likelihood of same day processing and final approval. Data were analyzed from July to December 2025.

Branded medication dispensations after initial PA rejections.

Percentage of same-day processed, and ultimately approved prescription medication dispensations.

The analysis included 205 896 branded medication dispensations that faced initial PA rejections from 156 848 patients (mean [SD] age, 55 [14] years; 109 227 females [70%] and 47 621 males [30%]) in the US. Of the total dispensed, 71 324 (35%) prescriptions were processed in 1 day, and the remaining 134 572 (65%) were processed during a median (IQR) of 6 (3-12) days. Of these, 111 758 (54%) were eventually approved. Medication prescriptions with multiple rounds of PA reviews, additional rejection reasons, or refills were associated with 37% (95% CI, 37%-37%), 39% (95% CI, 38%-39%), and 9% (95% CI, 9%-10%) lower probability of same-day processing, respectively. Medication fills from Medicaid patients or patients with multiple disease conditions had 8% (95% CI, 7%-8%) and 5% (95% CI, 4%-5%) lower approval rates, respectively.

This cross-sectional study suggests that most patients filling prescriptions that PA initially rejected experienced treatment delays and/or eventual denials. Claim adjudication complexity, prescription type, and patient characteristics were associated with these outcomes.