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Benefits Strategy

Prior Authorization: Benefits, Burdens, and Bold Ideas for Improvement

Prior authorizations have been a mainstay of utilization management strategies. Understanding the challenges they present for different stakeholders across the industry can lead to improved efficiency while helping employers remain steadfast to cost, quality, and member experience goals.

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March 24, 2025

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TABLE OF CONTENTS

  1. Introduction
  2. The Evolving Role of PA in Health Care
  3. Stakeholder Perspectives on the Prior Authorization Process
  4. The Role of Health Insurance Companies/Third-Party Administrators (TPA) and Pharmacy Benefit Managers (PBMs)
  5. Potential Avenues to Improving PA
  6. PA Policy Landscape
  7. Employer Recommendations
  8. Conclusion
  9. Appendix: Questions Employers Should Be Asking