Reducing GLP-1 prior authorization friction: a managed care playbook

High-cost glucagon-like peptide-1 therapies force payers to balance access and affordability, but many delays and abandonment events are driven less by coverage policy than by avoidable utilization management (UM) friction inside the prior authorization (PA) workflow. This article proposes a practical, reproducible PA Friction Index that payers and pharmacy benefit managers can calculate from existing UM and claims metadata to identify where friction concentrates, monitor equity-sensitive effects, and prioritize fixes that improve time-to-start metrics without loosening clinical safeguards. This commentary outlines the index's domains and measurable signals, describes where automation helps vs harms (and the guardrails needed), and provides a 90-day implementation checklist focused on standardizing criteria, expanding electronic PA, reducing rework, and continuously monitoring outcomes such as time to decision, abandonment, and appeals.