Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation
Key Points
Question For branded medication prescriptions that are initially rejected by the prior authorization (PA) review, how many are eventually approved and how much time does the process require?
Findings In this cross-sectional study of 205 896 medication dispensations initially rejected, 35% were processed in 1 day and 54% were eventually approved. Prescriptions with multiple PA reviews, additional rejection reasons, and refills were delayed and patients with Medicaid coverage or multiple disease conditions experienced fewer prescription approvals.
Meaning When filling a branded medication that was initially rejected by PA, most patients experienced treatment delays and/or eventual denials, outcomes that were associated with claim adjudication complexity, prescription type, and patient characteristics.
Abstract
Importance 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.
Objective 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.
Design, Setting, and Participants 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.
Exposure Branded medication dispensations after initial PA rejections.
Main Outcomes and Measures Percentage of same-day processed, and ultimately approved prescription medication dispensations.
Results 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.
Conclusions and Relevance 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.
Citation
Wang Y, Levy JF, Mattingly TJ, Anderson G. Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation. JAMA Health Forum. 2026;7(4):e260760. doi:10.1001/jamahealthforum.2026.0760