Administrative Burden
The time, paperwork and effort a system demands before it will deliver what someone is entitled to. In healthcare, it is the forms, phone calls, faxes and portals standing between a prescription and the patient — and the cost of getting through them falls on the clinic and the patient, not on the insurer that designed them.
Friction as a Filter
Policy researchers use the term for any process where the hassle itself screens people out. Every extra form, every unanswered call, every resubmission is a point where someone gives up. Nobody has to say "no" — the paperwork says it for them.
That is why administrative burden is not a side effect of prior authorization. For a plan trying to control spending, it is part of how prior authorization works. The care that is abandoned because the process was exhausting is care the plan never pays for.
What It Costs a Practice
39
prior authorizations per physician, per week
13 hrs
of physician and staff time each week
40%
of physicians have staff who work only on prior auth
Source: AMA prior authorization physician survey of 1,000 physicians, late 2024.
Who Pays for the Paper
The burden is lopsided by design. An insurer or pharmacy benefit manager writes a form once. Every clinic fills it out every time — printing it, completing it, faxing it back, waiting on hold — on its own paper, toner and payroll. On the insurer's side, a returned fax typically lands as a digital file.
Branching forms make it worse. A digital version can skip every question that does not apply. Printed, the clinic receives the entire decision tree — every "if checked, go to question 633" — and works through it by hand.
The Reform Track — and Its Gap
CMS's Interoperability and Prior Authorization Final Rule (CMS-0057-F, January 2024) requires Medicare Advantage, Medicaid and CHIP plans to answer prior authorization requests faster — 72 hours for urgent requests and 7 calendar days for standard ones, starting in 2026 — and requires affected payers, including federal Marketplace plans, to support electronic prior authorization by 2027.
The gaps: the rule covers medical items and services, not prescription drugs, so drug prior authorizations — the kind run through pharmacy benefit managers — are left out. And Marketplace plans are not held to the new decision timeframes.
Sources
Related Terms