What is the impact of prior authorization on access, utilization, and patient satisfaction?

• A. Prior authorization has no impact on access or utilization.
• B. Prior authorization can delay access and create administrative burden, but it helps ensure medical necessity, reduces inappropriate utilization, and can improve overall outcomes when implemented efficiently.
• C. Prior authorization always reduces patient satisfaction.
• D. Prior authorization replaces the need for clinical review.

Answer: (B)

Prior authorization acts as a gatekeeper in care delivery. It aims to ensure medical necessity and curb inappropriate utilization, which can improve overall outcomes when the process is well-aligned with evidence-based guidelines and runs efficiently.

The best answer recognizes both sides: it can delay access and add administrative burden, but when streamlined, it helps verify that services are appropriate and used in the right patients, ultimately supporting better outcomes. Efficient PA processes minimize unnecessary wait times and administrative hurdles, which supports patient satisfaction and timely care. Conversely, if approvals are slow or opaque, satisfaction declines and access is hindered, even if the goal is to prevent waste or inappropriate use. This balanced view explains why PA is not simply good or bad—it’s about how well the process is designed and implemented to balance access with appropriate utilization.